Individual
NANCY BOULOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5616G OX RD, FAIRFAX STATION, VA 22039-1018
(571) 404-0007
Mailing address
5616G OX RD, FAIRFAX STATION, VA 22039-1018
(571) 404-0007
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0202211927
VA
Other
Enumeration date
02/12/2021
Last updated
02/12/2021
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