Provider Demographics
NPI:1629342126
Name:ZAKHARY, MARIAM A
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:A
Last Name:ZAKHARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 12TH SQ SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-5067
Mailing Address - Country:US
Mailing Address - Phone:772-713-7309
Mailing Address - Fax:
Practice Address - Street 1:10400 S US HIGHWAY 1
Practice Address - Street 2:SUITE 200
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5600
Practice Address - Country:US
Practice Address - Phone:800-503-7663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist