Healthcare Provider Details

I. General information

NPI: 1073865101
Provider Name (Legal Business Name): MR. SHAHID MUNIR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2012
Last Update Date: 10/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 SNOW HILL RD UNIT 2
SALISBURY MD
21804-1900
US

IV. Provider business mailing address

807 MEADOW POINT RD
SALISBURY MD
21801-7422
US

V. Phone/Fax

Practice location:
  • Phone: 410-341-7474
  • Fax: 410-341-7473
Mailing address:
  • Phone: 410-341-7474
  • Fax: 410-341-7473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number14267
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: