Provider Demographics
NPI:1497574008
Name:PERVAIZ, ASLAM
Entity type:Individual
Prefix:
First Name:ASLAM
Middle Name:
Last Name:PERVAIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 OAK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-5945
Mailing Address - Country:US
Mailing Address - Phone:443-504-4301
Mailing Address - Fax:
Practice Address - Street 1:215 OAK VALLEY DR
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-5945
Practice Address - Country:US
Practice Address - Phone:443-504-4301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14412183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty