Healthcare Provider Details

I. General information

NPI: 1346170479
Provider Name (Legal Business Name): HANIYEH POURSAEID
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3559 BOSTON ST
BALTIMORE MD
21224-5750
US

IV. Provider business mailing address

12682 GRANITE RIDGE DR
NORTH POTOMAC MD
20878-3435
US

V. Phone/Fax

Practice location:
  • Phone: 410-703-6424
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number30740
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: