Healthcare Provider Details

I. General information

NPI: 1649574930
Provider Name (Legal Business Name): SILVANA M MUSTAK PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2010
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 POLO PKWY
MIDLOTHIAN VA
23113-4833
US

IV. Provider business mailing address

3001 POLO PKWY
MIDLOTHIAN VA
23113-4833
US

V. Phone/Fax

Practice location:
  • Phone: 804-379-2496
  • Fax: 804-379-7845
Mailing address:
  • Phone: 804-379-2496
  • Fax: 804-379-7845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0202206753
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: