Provider Demographics
NPI:1154825008
Name:ISMAIL, MARYAM (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:MARYAM
Middle Name:
Last Name:ISMAIL
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 1:832 AVENUE Z FL 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6213
Mailing Address - Country:US
Mailing Address - Phone:813-841-5464
Mailing Address - Fax:
Practice Address - Street 1:1070 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-5421
Practice Address - Country:US
Practice Address - Phone:813-841-5464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist