Provider Demographics
NPI:1851835813
Name:DIALLO, MARIAM (RPH)
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:DIALLO
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 1:145 WESTWAY APT 204
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1977
Mailing Address - Country:US
Mailing Address - Phone:202-604-2226
Mailing Address - Fax:
Practice Address - Street 1:8601 MARTIN LUTHER KING JR HWY
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-1500
Practice Address - Country:US
Practice Address - Phone:301-322-7314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-10
Last Update Date:2016-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24556183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist