MEDICARE: JINOUS GRANMAYEH RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0202205024	VA

General Provider Information

NPI Number	:	1427473511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JINOUS GRANMAYEH RPH

Provider Business Mailing Address
First Line	:	2011 WESTWOOD FOREST DR
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-5053
Country	:	US
Telephone Number	:	301-332-0234
Fax Number	:

Provider Business Practice Location Address
First Line	:	1392 CHAIN BRIDGE RD
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22101-3904
Country	:	US
Telephone Number	:	571-488-6030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2014
Last Update Date	:	02/26/2014

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