=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730007972
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALI KESHAVARZ PHARMD, PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2026
-----------------------------------------------------
Last Update Date | 07/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18306 CORNFLOWER RD
-----------------------------------------------------
City | BOYDS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20841-4383
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-313-9252
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18306 CORNFLOWER RD
-----------------------------------------------------
City | BOYDS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20841-4383
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-313-9252
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 30738
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------