MEDICARE: DR. PRIYA MOHAN PHARMD

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	26101	MD

General Provider Information

NPI Number	:	1881169191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRIYA MOHAN PHARMD

Provider Business Mailing Address
First Line	:	13002 BANKFOOT CT
Second Line	:
City	:	HERNDON
State	:	VA
Zip	:	20171-2300
Country	:	US
Telephone Number	:	703-869-9485
Fax Number	:

Provider Business Practice Location Address
First Line	:	2905 DISTRICT AVE
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-2273
Country	:	US
Telephone Number	:	703-869-9485
Fax Number	:

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

Provider Enumeration Date	:	10/12/2018
Last Update Date	:	10/12/2018

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