MEDICARE: FAHD MOHAMED SHARIFF

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician

General Provider Information

NPI Number	:	1720590631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAHD MOHAMED SHARIFF

Provider Business Mailing Address
First Line	:	26237 SOUTHFIELD RD
Second Line	:
City	:	LATHRUP VILLAGE
State	:	MI
Zip	:	48076-4546
Country	:	US
Telephone Number	:	248-728-4960
Fax Number	:	248-728-4962

Provider Business Practice Location Address
First Line	:	26237 SOUTHFIELD RD
Second Line	:
City	:	LATHRUP VILLAGE
State	:	MI
Zip	:	48076-4546
Country	:	US
Telephone Number	:	248-728-4960
Fax Number	:	248-728-4962

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2017
Last Update Date	:	11/01/2017

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