Provider Demographics
NPI:1154643765
Name:CHALOM, MIRIAM KATHERINE
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:KATHERINE
Last Name:CHALOM
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 1:401 STATE STREET
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619-1413
Mailing Address - Country:US
Mailing Address - Phone:315-493-0150
Mailing Address - Fax:315-493-3226
Practice Address - Street 1:401 STATE ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-1413
Practice Address - Country:US
Practice Address - Phone:315-493-0150
Practice Address - Fax:315-493-3226
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist