Provider Demographics
NPI:1003522194
Name:AZIZI, BAHAREH (PHARM-D)
Entity Type:Individual
Prefix:MS
First Name:BAHAREH
Middle Name:
Last Name:AZIZI
Suffix:
Gender:F
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6094 CAMERONS FERRY DR
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-3325
Mailing Address - Country:US
Mailing Address - Phone:540-209-2145
Mailing Address - Fax:
Practice Address - Street 1:25421 EASTERN MARKETPLACE PLZ
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-5780
Practice Address - Country:US
Practice Address - Phone:703-327-7817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202220896183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist