MEDICARE: MARIAM GHATTAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	76245	TX

General Provider Information

NPI Number	:	1578496097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAM GHATTAS

Provider Business Mailing Address
First Line	:	3711 PLUM VISTA PL
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76005-1115
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 S BOWEN RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-1255
Country	:	US
Telephone Number	:	817-277-0072
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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Directions to “ MARIAM GHATTAS ” Practice Location

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