Healthcare Provider Details

I. General information

NPI: 1255591723
Provider Name (Legal Business Name): REZA VAFA PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12222 VEIRS MILL RD
SILVER SPRING MD
20906-4505
US

IV. Provider business mailing address

14207 ARCTIC AVE
ROCKVILLE MD
20853-2249
US

V. Phone/Fax

Practice location:
  • Phone: 301-949-6212
  • Fax: 301-949-4926
Mailing address:
  • Phone: 301-949-6212
  • Fax: 301-949-4926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14645
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: