Provider Demographics
NPI:1972265387
Name:MOHAMMAD, MARIAM MAHMOOD (PHARM-D)
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:MAHMOOD
Last Name:MOHAMMAD
Suffix:
Gender:F
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006
Mailing Address - Country:US
Mailing Address - Phone:781-605-8642
Mailing Address - Fax:
Practice Address - Street 1:2921 IOWA AVE
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006
Practice Address - Country:US
Practice Address - Phone:781-605-8642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.023680183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPST.023680OtherLA PHARMACIST LICENSE NUMBER (ACTIVE)