Healthcare Provider Details

I. General information

NPI: 1205730439
Provider Name (Legal Business Name): SYED ASIM RAZA PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10901 W BROAD ST
GLEN ALLEN VA
23060-5935
US

IV. Provider business mailing address

36 GRANT WAY
PRINCETON NJ
08540-1693
US

V. Phone/Fax

Practice location:
  • Phone: 804-935-6916
  • Fax:
Mailing address:
  • Phone: 801-231-6185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202223829
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: