Healthcare Provider Details

I. General information

NPI: 1063799989
Provider Name (Legal Business Name): NANCY MEEHAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2011
Last Update Date: 11/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43250 SOUTHERN WALK PLZ
ASHBURN VA
20148-4462
US

IV. Provider business mailing address

43250 SOUTHERN WALK PLZ
ASHBURN VA
20148-4462
US

V. Phone/Fax

Practice location:
  • Phone: 703-729-0693
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202206698
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH100000215
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16807
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP037862L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: