Provider Demographics
NPI:1477139426
Name:GIRGIS, BASSEM (PHARMD)
Entity Type:Individual
Prefix:
First Name:BASSEM
Middle Name:
Last Name:GIRGIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23475 ROCK HAVEN WAY STE 105
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-4477
Mailing Address - Country:US
Mailing Address - Phone:855-792-5462
Mailing Address - Fax:855-792-5463
Practice Address - Street 1:23475 ROCK HAVEN WAY STE 105
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-4477
Practice Address - Country:US
Practice Address - Phone:855-792-5462
Practice Address - Fax:855-792-5463
Is Sole Proprietor?:No
Enumeration Date:2021-03-21
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist