Provider Demographics
NPI:1487897476
Name:MOKHTARI, CARON PATRICIA (PHARMD)
Entity type:Individual
Prefix:
First Name:CARON
Middle Name:PATRICIA
Last Name:MOKHTARI
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 1:11404 OLD BALTIMORE PIKE
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-2016
Mailing Address - Country:US
Mailing Address - Phone:240-413-2848
Mailing Address - Fax:301-937-3630
Practice Address - Street 1:11404 OLD BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2016
Practice Address - Country:US
Practice Address - Phone:240-413-2848
Practice Address - Fax:301-937-3630
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2013-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15443183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist