1770822959 NPI number — MS. QURAT Y MIR M PHARM

Table of content: MS. QURAT Y MIR M PHARM (NPI 1770822959)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770822959 NPI number — MS. QURAT Y MIR M PHARM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIR
Provider First Name:
QURAT
Provider Middle Name:
Y
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M PHARM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770822959
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2107 CROSS TRAILS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINDSOR MILL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21244-1255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-944-6373
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 N HOWARD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21201-3407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-951-5940
Provider Business Practice Location Address Fax Number:
410-951-5946
Provider Enumeration Date:
02/07/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  17765 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 17765 . This is a "MD PHARMACIST LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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