Provider Demographics
NPI:1861004343
Name:KHALIFE, MARIAM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:
Last Name:KHALIFE
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 1:15600 LONGMEADOW ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1026
Mailing Address - Country:US
Mailing Address - Phone:313-289-8695
Mailing Address - Fax:
Practice Address - Street 1:23241 EUREKA RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-5240
Practice Address - Country:US
Practice Address - Phone:734-287-3880
Practice Address - Fax:734-287-0633
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302043572183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist