Provider Demographics
NPI:1306477971
Name:IMAM, MARIA (PHARMD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:IMAM
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 1:3010 WALTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1264
Mailing Address - Country:US
Mailing Address - Phone:248-375-2810
Mailing Address - Fax:248-375-0668
Practice Address - Street 1:3010 WALTON BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1264
Practice Address - Country:US
Practice Address - Phone:248-375-2810
Practice Address - Fax:248-375-0668
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302044777183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist