Individual
ALI MAHBOBA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4606 KENMORE AVE, ALEXANDRIA, VA 22304-1301
(202) 769-8961
Mailing address
4606 KENMORE AVE, ALEXANDRIA, VA 22304-1301
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0202219295
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0202219295
BOARD F PHARMACY
VA
Enumeration date
10/18/2022
Last updated
10/18/2022
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