Provider Demographics
NPI:1669875399
Name:TADROS, FADY (INTERN PHARMACIST)
Entity type:Individual
Prefix:
First Name:FADY
Middle Name:
Last Name:TADROS
Suffix:
Gender:M
Credentials:INTERN PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 NEW HOPE CHURCH RD
Mailing Address - Street 2:APT 106
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6285
Mailing Address - Country:US
Mailing Address - Phone:919-790-9856
Mailing Address - Fax:
Practice Address - Street 1:1725 NEW HOPE CHURCH RD
Practice Address - Street 2:APT 106
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6285
Practice Address - Country:US
Practice Address - Phone:919-790-8956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26861183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist