Active NPI
Maryam Al Jazrawi
- Pharmacist
- Flat Rock, MI
National Provider Identifier
1609462985
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302413155
- Practice address
- 23007 Telegraph Rd
Flat Rock, MI 48134-9028 - Phone
- (734) 475-6663
- Fax
- (734) 675-8077
- NPI assigned
- Dec 21, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302413155 | MI | Primary |
Addresses
Primary practice location
23007 Telegraph Rd
Flat Rock, MI 48134-9028
Mailing address
1500 Stauch Dr
West Bloomfield, MI 48324-3117
Phone (248) 425-6620
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5302413155 | Medicaid | MI |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Walgreens |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302413155 | MI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1608508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1608508800000",
"number": "1609462985",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 STAUCH DR",
"city": "WEST BLOOMFIELD",
"state": "MI",
"postal_code": "483243117",
"telephone_number": "248-425-6620"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23007 TELEGRAPH RD",
"city": "FLAT ROCK",
"state": "MI",
"postal_code": "481349028",
"telephone_number": "734-475-6663",
"fax_number": "734-675-8077"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AL JAZRAWI",
"first_name": "MARYAM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-12-21",
"last_updated": "2020-12-21",
"certification_date": "2020-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302413155",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5302413155",
"state": "MI"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "Walgreens",
"affiliation": "N",
"address_1": "23007 Telegraph Rd",
"city": "Flat Rock",
"state": "MI",
"country_code": "US",
"postal_code": "481349028",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Flat Rock, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.