Provider Demographics
NPI:1699257808
Name:HAJI-HERSI, MARIAM
Entity type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:
Last Name:HAJI-HERSI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2271 BEL PRE RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2204
Mailing Address - Country:US
Mailing Address - Phone:301-598-6617
Mailing Address - Fax:
Practice Address - Street 1:15250 MONTANUS DR
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-2514
Practice Address - Country:US
Practice Address - Phone:540-727-8976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25255183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist