Provider Demographics
NPI:1295087518
Name:MAKLAD, NOHA
Entity type:Individual
Prefix:
First Name:NOHA
Middle Name:
Last Name:MAKLAD
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 1:900 HARFORD TURNPIKE
Mailing Address - Street 2:TARGET PHARMACY
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385
Mailing Address - Country:US
Mailing Address - Phone:860-442-3300
Mailing Address - Fax:
Practice Address - Street 1:900 HARTFORD TPKE
Practice Address - Street 2:TARGET PHARMACY
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-4246
Practice Address - Country:US
Practice Address - Phone:860-442-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0012153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist