Provider Demographics
NPI:1841981735
Name:MIRELES, MARIAH
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:MIRELES
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 1:6402 GOLDEN RING RD
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-2010
Mailing Address - Country:US
Mailing Address - Phone:410-866-2500
Mailing Address - Fax:410-866-2500
Practice Address - Street 1:6402 GOLDEN RING RD
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-2010
Practice Address - Country:US
Practice Address - Phone:410-866-2500
Practice Address - Fax:410-866-6486
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT27131183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician