Provider Demographics
NPI:1770822959
Name:MIR, QURAT Y (M PHARM)
Entity Type:Individual
Prefix:MS
First Name:QURAT
Middle Name:Y
Last Name:MIR
Suffix:
Gender:F
Credentials:M PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 CROSS TRAILS RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-1255
Mailing Address - Country:US
Mailing Address - Phone:410-944-6373
Mailing Address - Fax:
Practice Address - Street 1:6 N HOWARD ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-3407
Practice Address - Country:US
Practice Address - Phone:410-951-5940
Practice Address - Fax:410-951-5946
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD17765OtherMD PHARMACIST LICENSE