Provider Demographics
NPI:1518574813
Name:KHANJANI, SHARAREH
Entity Type:Individual
Prefix:
First Name:SHARAREH
Middle Name:
Last Name:KHANJANI
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 1:45780 MOUNTAIN PINE SQ
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-7214
Mailing Address - Country:US
Mailing Address - Phone:703-599-7676
Mailing Address - Fax:
Practice Address - Street 1:3535 RUSSETT GRN E
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-1810
Practice Address - Country:US
Practice Address - Phone:301-883-5974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist