Healthcare Provider Details

I. General information

NPI: 1942005475
Provider Name (Legal Business Name): MARIAM NABIL TOMA SAEGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 02/18/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40399 GRAND RIVER AVE STE 110
NOVI MI
48375-2123
US

IV. Provider business mailing address

40399 GRAND RIVER AVE STE 110
NOVI MI
48375-2123
US

V. Phone/Fax

Practice location:
  • Phone: 248-536-1576
  • Fax:
Mailing address:
  • Phone: 248-536-1576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5302417030
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: