Provider Demographics
NPI:1326381823
Name:HAIRSTON, LUJUANA FAYE (RPH)
Entity Type:Individual
Prefix:MR
First Name:LUJUANA
Middle Name:FAYE
Last Name:HAIRSTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12255 FAIR LAKES PKWY
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3952
Mailing Address - Country:US
Mailing Address - Phone:703-934-5711
Mailing Address - Fax:703-943-5835
Practice Address - Street 1:12255 FAIR LAKES PKWY
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-3952
Practice Address - Country:US
Practice Address - Phone:703-934-5711
Practice Address - Fax:703-943-5835
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009864183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist