Healthcare Provider Details

I. General information

NPI: 1487897476
Provider Name (Legal Business Name): CARON PATRICIA MOKHTARI PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 05/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11404 OLD BALTIMORE PIKE
BELTSVILLE MD
20705-2016
US

IV. Provider business mailing address

11404 OLD BALTIMORE PIKE
BELTSVILLE MD
20705-2016
US

V. Phone/Fax

Practice location:
  • Phone: 240-413-2848
  • Fax: 301-937-3630
Mailing address:
  • Phone: 240-413-2848
  • Fax: 301-937-3630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15443
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: