Provider Demographics
NPI:1649820515
Name:SROUR, SALMA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SALMA
Middle Name:
Last Name:SROUR
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 1:2449 RABBITS RUN ST
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-4970
Mailing Address - Country:US
Mailing Address - Phone:240-461-1789
Mailing Address - Fax:
Practice Address - Street 1:6260 CRAIN HWY
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-4258
Practice Address - Country:US
Practice Address - Phone:301-934-9564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD219963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21996OtherCAREMARK
MD21996OtherCASH
MD21996Medicaid