Individual
AMENATE IBERAHME
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13059 FAIR LAKES PARKWAY, FAIRFAX, VA 22033
(703) 631-4007
Mailing address
102 SHEPHERDSON LN NE, VIENNA, VA 22180-4532
(404) 957-3309
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0202213514
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0202213514
DEPARTMENT OF HEALTH PROFESSIONS (BOARD OF PHARMACY)
VA
Enumeration date
11/13/2020
Last updated
11/13/2020
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