Healthcare Provider Details

I. General information

NPI: 1417091901
Provider Name (Legal Business Name): BEHNAM KAMRAD PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12255 FAIR LAKES PKWY
FAIRFAX VA
22033-3952
US

IV. Provider business mailing address

PO BOX 2249
MERRIFIELD VA
22116-2249
US

V. Phone/Fax

Practice location:
  • Phone: 703-934-5800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202011893
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14370
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: