Healthcare Provider Details

I. General information

NPI: 1962323766
Provider Name (Legal Business Name): ANAMIKA RAJ SRIVASTAVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 ALAN SHEPARD ST
HERNDON VA
20171-4196
US

IV. Provider business mailing address

3045 ALAN SHEPARD ST
HERNDON VA
20171-4196
US

V. Phone/Fax

Practice location:
  • Phone: 703-400-3324
  • Fax:
Mailing address:
  • Phone: 703-400-3324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0245011483
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: