Healthcare Provider Details

I. General information

NPI: 1275353674
Provider Name (Legal Business Name): MR. MOHAMMED AHSANUL HOQUE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9372 RICHMOND HWY
LORTON VA
22079-1827
US

IV. Provider business mailing address

5419 BANTRY CT
WOODBRIDGE VA
22193-3170
US

V. Phone/Fax

Practice location:
  • Phone: 571-642-0103
  • Fax:
Mailing address:
  • Phone: 571-534-8187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202222380
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: