Individual
SUSAN TAVAKOLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3046 MISSION SQUARE DR, FAIRFAX, VA 22031-1113
(757) 334-4514
Mailing address
3046 MISSION SQUARE DR, FAIRFAX, VA 22031-1113
(757) 334-4514
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
0202216060
VA
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
10/07/2019
Last updated
10/07/2019
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