MEDICARE: NAJRA MARIC PHARMD

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	RPH031380	GA

General Provider Information

NPI Number	:	1992337125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAJRA MARIC PHARMD

Provider Business Mailing Address
First Line	:	2620 TYLER BAY LN
Second Line	:
City	:	GRAYSON
State	:	GA
Zip	:	30017-7880
Country	:	US
Telephone Number	:	404-451-8264
Fax Number	:

Provider Business Practice Location Address
First Line	:	5900 E LAKE PKWY
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-4802
Country	:	US
Telephone Number	:	770-954-4389
Fax Number	:

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

Provider Enumeration Date	:	02/05/2020
Last Update Date	:	02/05/2020

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