Healthcare Provider Details

I. General information

NPI: 1831093194
Provider Name (Legal Business Name): MARYAM MOGHIMI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6720A ROCKLEDGE DR
BETHESDA MD
20817-1888
US

IV. Provider business mailing address

1200 CHADSWORTH CT
MC LEAN VA
22102-2319
US

V. Phone/Fax

Practice location:
  • Phone: 240-694-2000
  • Fax:
Mailing address:
  • Phone: 443-447-3521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number26107
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: