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General NPI Number Information
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NPI Number | 1649453747
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Entity Type | Individual
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Provider Name | MAHNAZ M KHORRAMI RPH
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Gender | Female
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 12/11/2007
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Provider Practice Location Address
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Address Line | 1024 NORTH AVE
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City | BURLINGTON
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State | VT
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Zip | 05408-2753
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Country | US
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Telephone | 802-865-7822
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Fax |
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Provider Business Mailing Address
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Address Line | 27 PINNACLE DR
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05403-7914
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Country | US
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Telephone | 802-860-0624
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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 | 033-0003316
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License Number State | VT
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