Provider Demographics
NPI:1114433810
Name:NIYAMATHULLAH, RESHMA
Entity Type:Individual
Prefix:
First Name:RESHMA
Middle Name:
Last Name:NIYAMATHULLAH
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 1:300 CORMORANT PL APT 2422
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-1982
Mailing Address - Country:US
Mailing Address - Phone:908-568-3414
Mailing Address - Fax:
Practice Address - Street 1:228 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:THURMONT
Practice Address - State:MD
Practice Address - Zip Code:21788-1638
Practice Address - Country:US
Practice Address - Phone:301-271-7094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25324183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist