Individual
MIRA MINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
11680 PLAZA AMERICA DR, RESTON, VA 20190-4700
(703) 481-5722
Mailing address
4724 WARM HEARTH CIR, FAIRFAX, VA 22033-5076
(571) 365-8817
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0202219598
VA
Other
Enumeration date
09/26/2022
Last updated
09/26/2022
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