Provider Demographics
NPI:1477824258
Name:MALAVIA, MANISHA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MANISHA
Middle Name:
Last Name:MALAVIA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 OLD LEE HWY
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-1806
Mailing Address - Country:US
Mailing Address - Phone:703-246-7113
Mailing Address - Fax:
Practice Address - Street 1:3750 OLD LEE HWY
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-1806
Practice Address - Country:US
Practice Address - Phone:703-246-7113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist