Provider Demographics
NPI:1851675698
Name:ALSHARIFI, MAITHAM (RPH)
Entity Type:Individual
Prefix:
First Name:MAITHAM
Middle Name:
Last Name:ALSHARIFI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41452 SINGH DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2645
Mailing Address - Country:US
Mailing Address - Phone:313-930-2185
Mailing Address - Fax:
Practice Address - Street 1:19800 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-1234
Practice Address - Country:US
Practice Address - Phone:313-273-9219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033921183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7526620001Medicare NSC