Provider Demographics
NPI:1881447746
Name:JABRO, MARIAM RAIED (PHD)
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:RAIED
Last Name:JABRO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:MARIAM
Other - Middle Name:R
Other - Last Name:JABRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:23391 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3103
Mailing Address - Country:US
Mailing Address - Phone:248-474-3123
Mailing Address - Fax:
Practice Address - Street 1:23391 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-3103
Practice Address - Country:US
Practice Address - Phone:248-442-3123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302414875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist