Healthcare Provider Details

I. General information

NPI: 1417240730
Provider Name (Legal Business Name): NIKOO FAGHIH RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6845 ELM ST STE 105
MC LEAN VA
22101-3822
US

IV. Provider business mailing address

6845 ELM ST STE 105
MC LEAN VA
22101-3822
US

V. Phone/Fax

Practice location:
  • Phone: 703-338-0828
  • Fax: 703-388-0826
Mailing address:
  • Phone: 703-338-0828
  • Fax: 703-388-0826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19575
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202209881
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: