Healthcare Provider Details

I. General information

NPI: 1326743386
Provider Name (Legal Business Name): MERAL E-ABDULMENAM EBRAHEM PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 N BECK RD
PLYMOUTH MI
48170-3377
US

IV. Provider business mailing address

19055 GILL RD
LIVONIA MI
48152-3051
US

V. Phone/Fax

Practice location:
  • Phone: 877-689-8697
  • Fax: 734-354-5992
Mailing address:
  • Phone: 313-333-8668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302414947
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: