Provider Demographics
NPI:1043439482
Name:MEAZA, YARED (RPH)
Entity type:Individual
Prefix:MR
First Name:YARED
Middle Name:
Last Name:MEAZA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 RANDOLPH RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-1307
Mailing Address - Country:US
Mailing Address - Phone:240-514-1009
Mailing Address - Fax:
Practice Address - Street 1:2201 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-1307
Practice Address - Country:US
Practice Address - Phone:240-514-1009
Practice Address - Fax:240-514-1012
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD12320OtherPHARMACIST LICENSE