Provider Demographics
NPI:1407458961
Name:KHEIRI, SHIAMA SAMIR
Entity Type:Individual
Prefix:
First Name:SHIAMA
Middle Name:SAMIR
Last Name:KHEIRI
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 1:240 ELIZABETH DR
Mailing Address - Street 2:
Mailing Address - City:STEPHENS CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22655-2764
Mailing Address - Country:US
Mailing Address - Phone:540-868-0663
Mailing Address - Fax:844-411-6889
Practice Address - Street 1:240 ELIZABETH DR
Practice Address - Street 2:
Practice Address - City:STEPHENS CITY
Practice Address - State:VA
Practice Address - Zip Code:22655-2764
Practice Address - Country:US
Practice Address - Phone:540-868-0663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA020017104183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist