Healthcare Provider Details

I. General information

NPI: 1336740174
Provider Name (Legal Business Name): GOLNAZ REZVANI RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 NORTH POINT VILLAGE CENTER
RESTON VA
20194
US

IV. Provider business mailing address

1450 NORTHPOINT VILLAGE CTR
RESTON VA
20194-1190
US

V. Phone/Fax

Practice location:
  • Phone: 703-437-0037
  • Fax: 844-411-6507
Mailing address:
  • Phone: 703-437-0037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202012300
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: