Provider Demographics
NPI:1568716710
Name:TAVAKOLI, GITA (RPH)
Entity Type:Individual
Prefix:
First Name:GITA
Middle Name:
Last Name:TAVAKOLI
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 1:8901 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-0004
Mailing Address - Country:US
Mailing Address - Phone:301-295-2121
Mailing Address - Fax:301-295-6136
Practice Address - Street 1:8901 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-3358
Practice Address - Country:US
Practice Address - Phone:301-295-2121
Practice Address - Fax:301-295-6136
Is Sole Proprietor?:No
Enumeration Date:2012-11-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH3257183500000X
VA0202010939183500000X
MD12874183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist