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General NPI Number Information
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NPI Number | 1639985351
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Entity Type | Individual
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Provider Name | JANNAT IJAZ PHARMD
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Gender | Female
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Dates
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Enumeration Date | 12/06/2024
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Last Update Date | 12/08/2024
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Provider Practice Location Address
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Address Line | 7500 CENTREVILLE RD
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City | MANASSAS PARK
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State | VA
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Zip | 20111-1743
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Country | US
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Telephone | 703-369-1920
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Fax |
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Provider Business Mailing Address
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Address Line | 172 LAUREL WAY APT 2B
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City | HERNDON
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State | VA
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Zip | 20170-4432
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Country | US
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Telephone | 571-653-0565
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0202222489
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License Number State | VA
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