Provider Demographics
NPI:1144951443
Name:ALSURAIH, FARAH
Entity type:Individual
Prefix:
First Name:FARAH
Middle Name:
Last Name:ALSURAIH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4619 TUNDRA LN NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-2286
Mailing Address - Country:US
Mailing Address - Phone:507-722-8831
Mailing Address - Fax:
Practice Address - Street 1:955 FRONTENAC DR
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-6522
Practice Address - Country:US
Practice Address - Phone:507-452-0615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-19
Last Update Date:2022-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN125563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist