Provider Demographics
NPI:1346630019
Name:MUSE, IYANA VENIA (PT)
Entity Type:Individual
Prefix:
First Name:IYANA
Middle Name:VENIA
Last Name:MUSE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8036 BLOOMSBURY PL
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3495
Mailing Address - Country:US
Mailing Address - Phone:301-885-7710
Mailing Address - Fax:
Practice Address - Street 1:15922 CRAIN HWY
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-8047
Practice Address - Country:US
Practice Address - Phone:301-720-9001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT04416183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician