Provider Demographics
NPI:1457675340
Name:KHEIRABI, MARYAM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:
Last Name:KHEIRABI
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 1:26181 LANGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1040
Mailing Address - Country:US
Mailing Address - Phone:212-444-2265
Mailing Address - Fax:
Practice Address - Street 1:26181 LANGSTON AVE
Practice Address - Street 2:
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1040
Practice Address - Country:US
Practice Address - Phone:212-444-2265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-21
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053168183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist