Provider Demographics
NPI:1528368602
Name:GHARAD, NESRA (RPH)
Entity Type:Individual
Prefix:
First Name:NESRA
Middle Name:
Last Name:GHARAD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43150 BROADLANDS CENTER PLZ
Mailing Address - Street 2:SUITE 140
Mailing Address - City:BROADLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:20148-3800
Mailing Address - Country:US
Mailing Address - Phone:703-726-1374
Mailing Address - Fax:703-726-1371
Practice Address - Street 1:43150 BROADLANDS CENTER PLZ
Practice Address - Street 2:SUITE 140
Practice Address - City:BROADLANDS
Practice Address - State:VA
Practice Address - Zip Code:20148-3800
Practice Address - Country:US
Practice Address - Phone:703-726-1374
Practice Address - Fax:703-726-1379
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-23
Last Update Date:2010-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist