Provider Demographics
NPI:1407445166
Name:MEMON, MAHIREEN P (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MAHIREEN
Middle Name:P
Last Name:MEMON
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 1:6577 NW 109TH AVE
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3801
Mailing Address - Country:US
Mailing Address - Phone:469-363-8100
Mailing Address - Fax:
Practice Address - Street 1:101 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-3359
Practice Address - Country:US
Practice Address - Phone:561-547-5289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS48925183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist