Provider Demographics
NPI:1245620004
Name:HAHN, AMY ELIZABETH
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:HAHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 AVENIR PL
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-7176
Mailing Address - Country:US
Mailing Address - Phone:703-698-8510
Mailing Address - Fax:703-698-8676
Practice Address - Street 1:2675 AVENIR PL
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-7176
Practice Address - Country:US
Practice Address - Phone:703-698-8510
Practice Address - Fax:703-698-8676
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0203014589183700000X
VA0202214188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No183700000XPharmacy Service ProvidersPharmacy Technician