Provider Demographics
NPI:1053008474
Name:SOBHANIAN, MILLAD JOHN (PHARMD)
Entity type:Individual
Prefix:
First Name:MILLAD
Middle Name:JOHN
Last Name:SOBHANIAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 NORMANDY WOODS DR APT J
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4153
Mailing Address - Country:US
Mailing Address - Phone:146-932-3342
Mailing Address - Fax:
Practice Address - Street 1:16 S EUTAW ST STE 300
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1698
Practice Address - Country:US
Practice Address - Phone:410-328-4323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD31648741835P0018X
TX65030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist