Healthcare Provider Details

I. General information

NPI: 1497268130
Provider Name (Legal Business Name): MARYAM IRANIKHAH PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 LAKESHORE DR
BIRMINGHAM AL
35229-0001
US

IV. Provider business mailing address

SAMFORD UNIVERSITY MCWHORTER SCHOOL OF PHARMACY 800 LAKESHORE DRIVE
BIRMINGHAM AL
35229-0001
US

V. Phone/Fax

Practice location:
  • Phone: 205-726-2086
  • Fax:
Mailing address:
  • Phone: 205-726-2086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number14457
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: