Healthcare Provider Details

I. General information

NPI: 1477093417
Provider Name (Legal Business Name): RAFFI VARTANIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 YOAKUM PKWY APT 809
ALEXANDRIA VA
22304-3936
US

IV. Provider business mailing address

309 YOAKUM PKWY APT 809
ALEXANDRIA VA
22304-3936
US

V. Phone/Fax

Practice location:
  • Phone: 571-490-1563
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number23599
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: