=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417240730
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NIKOO FAGHIH RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2011
-----------------------------------------------------
Last Update Date | 05/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6845 ELM ST STE 105
-----------------------------------------------------
City | MC LEAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22101-3822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-338-0828
-----------------------------------------------------
Fax | 703-388-0826
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6845 ELM ST STE 105
-----------------------------------------------------
City | MC LEAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22101-3822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-338-0828
-----------------------------------------------------
Fax | 703-388-0826
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 19575
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 0202209881
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------