Provider Demographics
NPI:1275423592
Name:MITRY, MERIAM NADER RAGHEB
Entity type:Individual
Prefix:
First Name:MERIAM
Middle Name:NADER RAGHEB
Last Name:MITRY
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 1:2 ROD CIR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769-7868
Mailing Address - Country:US
Mailing Address - Phone:331-250-6343
Mailing Address - Fax:
Practice Address - Street 1:402 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6208
Practice Address - Country:US
Practice Address - Phone:301-663-4861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-08
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist