Individual
ATA DIZDAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8607 LIBERTY RD, RANDALLSTOWN, MD 21133-4713
(410) 521-9520
Mailing address
12502 DEGAS CT, NORTH POTOMAC, MD 20878-3438
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
0202210252
VA
183500000X
Pharmacist
Primary
19522
MD
Other
Enumeration date
06/11/2024
Last updated
06/11/2024
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