Provider Demographics
NPI:1437472370
Name:MEYERS, MARIAM MILLIAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:MILLIAN
Last Name:MEYERS
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 1:246 LATHAM RD
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2245
Mailing Address - Country:US
Mailing Address - Phone:516-567-2469
Mailing Address - Fax:
Practice Address - Street 1:751 HAWKINS AVE
Practice Address - Street 2:
Practice Address - City:LAKE RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-2208
Practice Address - Country:US
Practice Address - Phone:631-467-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-06
Last Update Date:2010-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0541641183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist