Nancy Boulos

Primary specialty

PharmacistTaxonomy code 183500000X

License

0202211927 Issued in VA

Practice address

5616G Ox Rd
Fairfax Station, VA 22039-1018

Phone

(571) 404-0007

NPI assigned

Feb 12, 2021

Last updated

Feb 12, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1613088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613088000000",
    "number": "1952994717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5616G OX RD",
            "city": "FAIRFAX STATION",
            "state": "VA",
            "postal_code": "220391018",
            "telephone_number": "571-404-0007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5616G OX RD",
            "city": "FAIRFAX STATION",
            "state": "VA",
            "postal_code": "220391018",
            "telephone_number": "571-404-0007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULOS",
        "first_name": "NANCY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-12",
        "last_updated": "2021-02-12",
        "certification_date": "2021-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "VA",
            "license": "0202211927",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@myneighborpharmacy.com",
            "affiliation": "N",
            "endpointDescription": "work email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Fairfax Station",
            "address_1": "5616G Ox Rd",
            "city": "Fairfax Station",
            "state": "VA",
            "country_code": "US",
            "postal_code": "220391018",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Eliska Amyx, PTA
• Melaku Ayalew, M.D.
• Kord Hall Basnight, RESIDENT IN COUNSELI
• Leesa Foster Blum, M.ED.
• Tiffany Abena Manu Boakye, PHARMD.
• Carl Buising, MD
• Camericare Health Services
• Jessica May Cantu-Lane, PTA
• Kaitlin Renae Carlisle
• Ace Carter

• Pharmacist in Fairfax Station, VA
• Providers in Fairfax Station, VA by specialty
• Pharmacist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.