Healthcare Provider Details

I. General information

NPI: 1205746419
Provider Name (Legal Business Name): MARYAM REHMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 LAWRENCEVILLE SUWANEE RD
SUWANEE GA
30024-2645
US

IV. Provider business mailing address

2650 PEREGRINE CT
SUWANEE GA
30024-2973
US

V. Phone/Fax

Practice location:
  • Phone: 678-377-5258
  • Fax:
Mailing address:
  • Phone: 470-908-9401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH036239
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: