Healthcare Provider Details

I. General information

NPI: 1831884899
Provider Name (Legal Business Name): NAZO AFZAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8421 BROAD ST
MC LEAN VA
22102-3704
US

IV. Provider business mailing address

994 MANDEVILLE ST
MANTECA CA
95337-7950
US

V. Phone/Fax

Practice location:
  • Phone: 209-814-0383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202222640
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: