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General NPI Number Information
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NPI Number | 1528579331
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Entity Type | Individual
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Provider Name | MAHMOUD SROUR
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Gender | Male
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Dates
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Enumeration Date | 10/19/2017
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Last Update Date | 10/19/2017
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Provider Practice Location Address
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Address Line | 4100 WOODWARD AVE STE PHARMACY
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City | DETROIT
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State | MI
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Zip | 48201-2173
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Country | US
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Telephone | 313-832-5900
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Fax | 313-832-5901
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Provider Business Mailing Address
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Address Line | 5940 MIDDLESEX ST
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City | DEARBORN
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State | MI
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Zip | 48126-2166
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Country | US
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Telephone | 313-445-5656
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302041136
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License Number State | MI
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