Most Relevant Information
Provider Data
| NPI Number: | 1003658063 |
| Provider Name: | ATA DIZDAR |
| Entity Type: | Individual |
| Taxonomy Code: | 183500000X |
| Specialty: | Pharmacist |
| License Number: | 0202210252 |
Most Important Dates
| Enumeration Date: | 06/11/2024 |
| Last Updated: | 06/11/2024 |
Provider Practice Location
8607 LIBERTY RD
RANDALLSTOWN
MD
211334713
Practice Location Phone/Fax
| Phone: | 4105219520 |
| Fax: |
Provider Mailing Location
12502 DEGAS CT
NORTH POTOMAC
MD
208783438
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |