Provider Demographics
NPI:1306115720
Name:TAWADROS, MARIAM IKLADIOUS (RPH)
Entity type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:IKLADIOUS
Last Name:TAWADROS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10110 LYONS RD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33473-4701
Mailing Address - Country:US
Mailing Address - Phone:561-882-1523
Mailing Address - Fax:
Practice Address - Street 1:10110 LYONS RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33473-4701
Practice Address - Country:US
Practice Address - Phone:561-882-1523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46574183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist