Provider Demographics
NPI:1770392748
Name:SHRYIM, MOHAMMAD MAHMOUD
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:MAHMOUD
Last Name:SHRYIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 SHERBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3653
Mailing Address - Country:US
Mailing Address - Phone:313-575-9655
Mailing Address - Fax:
Practice Address - Street 1:10915 BELLEVILLE RD
Practice Address - Street 2:
Practice Address - City:VAN BUREN TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48111-1386
Practice Address - Country:US
Practice Address - Phone:734-697-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-04
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302415480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist