Provider Demographics
NPI:1841892908
Name:BOKTOR, MARIAM LAMEY
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:LAMEY
Last Name:BOKTOR
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 1:24635 DULLES LANDING DR
Mailing Address - Street 2:
Mailing Address - City:DULLES
Mailing Address - State:VA
Mailing Address - Zip Code:20166-2614
Mailing Address - Country:US
Mailing Address - Phone:571-367-3038
Mailing Address - Fax:571-367-3037
Practice Address - Street 1:24635 DULLES LANDING DR
Practice Address - Street 2:
Practice Address - City:DULLES
Practice Address - State:VA
Practice Address - Zip Code:20166-2614
Practice Address - Country:US
Practice Address - Phone:571-367-3038
Practice Address - Fax:571-367-3037
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202219213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist