Mirna Abujrab Kallas
Individual provider Active NPI Pharmacist · Fairfax, VA
NPI 1831780964 · NPPES record last updated Feb 1, 2021
Key facts
- NPI
- 1831780964
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 0202208357 (VA)
- Practice address
- 3053 Nutley St
Fairfax, VA 22031-1931 - Phone
- (703) 560-4862
- NPI assigned
- Feb 1, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0202208357 | VA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0202208357 | VA | Yes |
Addresses
Primary practice location
3053 Nutley St
Fairfax, VA 22031-1931
Mailing address
8324 Woodlea Mill Rd
MC Lean, VA 22102-2321
Phone (703) 623-1180
Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 1, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.