Provider Demographics
NPI:1427365170
Name:ABRAHAM, SHYAM (BPHARM)
Entity Type:Individual
Prefix:
First Name:SHYAM
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9240 HINES ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-1365
Mailing Address - Country:US
Mailing Address - Phone:412-531-4579
Mailing Address - Fax:
Practice Address - Street 1:238 MCMECHEN ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-4301
Practice Address - Country:US
Practice Address - Phone:410-523-4704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18234183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist