MEDICARE: KHATEREH SALEH KHORRAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH035985	GA

General Provider Information

NPI Number	:	1588595722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHATEREH SALEH KHORRAM

Provider Business Mailing Address
First Line	:	2638 BRIARCREST CT
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-5286
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3299 CANTON RD
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-3833
Country	:	US
Telephone Number	:	770-218-8588
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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