Provider Demographics
NPI:1942712146
Name:MAKLAD, MIRIAM MOKHTAR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:MOKHTAR
Last Name:MAKLAD
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 1:4767 CROWN LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-8901
Mailing Address - Country:US
Mailing Address - Phone:612-670-0817
Mailing Address - Fax:
Practice Address - Street 1:2401 E NORTH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-1401
Practice Address - Country:US
Practice Address - Phone:864-244-1851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC372441835P0018X
MN1231161835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist