Provider Demographics
NPI:1518216506
Name:AGHA, VIRGINIA
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:
Last Name:AGHA
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:VIRGINIA
Other - Middle Name:
Other - Last Name:NOVACEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15912 E KIM DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-1828
Mailing Address - Country:US
Mailing Address - Phone:775-233-2506
Mailing Address - Fax:
Practice Address - Street 1:1445 W ELLIOT RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1103
Practice Address - Country:US
Practice Address - Phone:480-893-9027
Practice Address - Fax:480-893-9173
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17977183500000X
CA42217183500000X
NV15567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist