Healthcare Provider Details

I. General information

NPI: 1124714050
Provider Name (Legal Business Name): MARIAM MAHMOUD MOMANI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9888 GENESEE AVE
LA JOLLA CA
92037-1205
US

IV. Provider business mailing address

5410 MCGRATH BLVD APT 256
NORTH BETHESDA MD
20852-8734
US

V. Phone/Fax

Practice location:
  • Phone: 858-834-1798
  • Fax:
Mailing address:
  • Phone: 240-413-0834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number29280
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: