Healthcare Provider Details

I. General information

NPI: 1881516391
Provider Name (Legal Business Name): MARIAM ELANNAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 NW 170TH ST
NORTH MIAMI BEACH FL
33169-5576
US

IV. Provider business mailing address

6372 NW 173RD ST
HIALEAH FL
33015-4464
US

V. Phone/Fax

Practice location:
  • Phone: 305-654-3155
  • Fax:
Mailing address:
  • Phone: 786-992-1094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS70539
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: