Healthcare Provider Details

I. General information

NPI: 1306550389
Provider Name (Legal Business Name): MALIKAH DHAKIRAH SALEEM PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2023
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4139 WHEELER RD SE STE A
WASHINGTON DC
20032-4346
US

IV. Provider business mailing address

4139 WHEELER RD SE STE A
WASHINGTON DC
20032-4346
US

V. Phone/Fax

Practice location:
  • Phone: 888-889-9961
  • Fax: 888-880-0073
Mailing address:
  • Phone: 888-889-9961
  • Fax: 888-880-0073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPT01155
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: