Healthcare Provider Details

I. General information

NPI: 1114433810
Provider Name (Legal Business Name): RESHMA NIYAMATHULLAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2017
Last Update Date: 12/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 N CHURCH ST
THURMONT MD
21788-1638
US

IV. Provider business mailing address

300 CORMORANT PL APT 2422
FREDERICK MD
21701-1982
US

V. Phone/Fax

Practice location:
  • Phone: 301-271-7094
  • Fax:
Mailing address:
  • Phone: 908-568-3414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25324
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: