Provider Demographics
NPI:1437897550
Name:AL-EBRAHEEM, MARYAM MOHAMMED (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:MOHAMMED
Last Name:AL-EBRAHEEM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7820 ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1012
Mailing Address - Country:US
Mailing Address - Phone:313-394-9427
Mailing Address - Fax:
Practice Address - Street 1:7210 N MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-2502
Practice Address - Country:US
Practice Address - Phone:734-427-5958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302414081183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist