Healthcare Provider Details

I. General information

NPI: 1043143415
Provider Name (Legal Business Name): ROSHAN HUSSAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 40TH ST N
ARLINGTON VA
22207-4805
US

IV. Provider business mailing address

4100 40TH ST N
ARLINGTON VA
22207-4805
US

V. Phone/Fax

Practice location:
  • Phone: 720-243-9792
  • Fax: 720-243-9792
Mailing address:
  • Phone: 720-243-9792
  • Fax: 720-243-9792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number051291085
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: