Healthcare Provider Details

I. General information

NPI: 1740942648
Provider Name (Legal Business Name): SURA YOUNUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44835 RUSSELL BRANCH PKWY
ASHBURN VA
20147-2984
US

IV. Provider business mailing address

44835 RUSSELL BRANCH PKWY
ASHBURN VA
20147-2984
US

V. Phone/Fax

Practice location:
  • Phone: 571-223-0006
  • Fax:
Mailing address:
  • Phone: 571-223-0006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202219982
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: