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General NPI Number Information
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NPI Number | 1316453145
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Entity Type | Individual
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Provider Name | MIRA AZIZ
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Gender | Female
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Dates
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Enumeration Date | 12/15/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 6260 CRAIN HWY
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City | LA PLATA
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State | MD
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Zip | 20646-4258
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Country | US
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Telephone | 301-934-9564
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Fax |
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Provider Business Mailing Address
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Address Line | 260 S REYNOLDS ST APT 809
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City | ALEXANDRIA
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State | VA
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Zip | 22304-4433
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Country | US
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Telephone | 571-290-8572
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 24645
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License Number State | MD
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