Healthcare Provider Details

I. General information

NPI: 1235056169
Provider Name (Legal Business Name): RAKIYA WADA SADIQ PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10539 BITTERSWEET LN
BRISTOW VA
20136-2225
US

IV. Provider business mailing address

10539 BITTERSWEET LN
BRISTOW VA
20136-2225
US

V. Phone/Fax

Practice location:
  • Phone: 336-308-6443
  • Fax:
Mailing address:
  • Phone: 336-308-6443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302416685
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: