Provider Demographics
NPI:1649742198
Name:KHAYATIAN, FATEMEH (PHARM D)
Entity Type:Individual
Prefix:
First Name:FATEMEH
Middle Name:
Last Name:KHAYATIAN
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 1:3410 BARNHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-2681
Mailing Address - Country:US
Mailing Address - Phone:201-410-5715
Mailing Address - Fax:
Practice Address - Street 1:975 BAY RIDGE RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-3934
Practice Address - Country:US
Practice Address - Phone:443-268-7688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist