MEDICARE: HENNA SHAMIM PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0202214545	VA

General Provider Information

NPI Number	:	1942675509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENNA SHAMIM PHARMD

Provider Business Mailing Address
First Line	:	2909 CHARING CROSS RD APT 16
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22042-1178
Country	:	US
Telephone Number	:	703-501-2190
Fax Number	:

Provider Business Practice Location Address
First Line	:	2909 CHARING CROSS RD APT 16
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22042-1178
Country	:	US
Telephone Number	:	703-501-2190
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2015
Last Update Date	:	12/08/2015

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