Individual provider Active NPI

Maryam Alizadeh-Miab

  • Pharmacist
  • Glendale, AZ
National Provider Identifier
1558017020
Registry record updated Feb 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
S025742 Issued in AZ
Practice address
6012 W Blackhawk Dr
Glendale, AZ 85308-6704
Phone
(480) 501-8084
NPI assigned
Feb 23, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 23, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X S025742 AZ Primary

Addresses

Primary practice location

6012 W Blackhawk Dr
Glendale, AZ 85308-6704

Mailing address

6012 W Blackhawk Dr
Glendale, AZ 85308-6704
Phone (480) 501-8084

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
S025742AZMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Wellness Pharmacy Inc. Current Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1645574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645574400000",
    "number": "1558017020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6012 W BLACKHAWK DR",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853086704",
            "telephone_number": "480-501-8084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6012 W BLACKHAWK DR",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853086704",
            "telephone_number": "480-501-8084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALIZADEH-MIAB",
        "first_name": "MARYAM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-23",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AZ",
            "license": "S025742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.