Healthcare Provider Details

I. General information

NPI: 1053785261
Provider Name (Legal Business Name): KRYSTEL NASR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2015
Last Update Date: 11/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14139 POTOMAC MILLS RD
WOODBRIDGE VA
22192-4644
US

IV. Provider business mailing address

2032 BLUNT LN
ALEXANDRIA VA
22303-1750
US

V. Phone/Fax

Practice location:
  • Phone: 703-490-8400
  • Fax:
Mailing address:
  • Phone: 571-232-9009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number0202212823
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: