Provider Demographics
NPI:1982246914
Name:AZIMI, MARIAM (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:
Last Name:AZIMI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9229 QUEENS BLVD STE CU13
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1045
Mailing Address - Country:US
Mailing Address - Phone:917-832-6753
Mailing Address - Fax:
Practice Address - Street 1:9229 QUEENS BLVD STE CU13
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1045
Practice Address - Country:US
Practice Address - Phone:917-832-6753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI066215-01183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist