Provider Demographics
NPI:1619268232
Name:GHATTAS, MICHAEL ANWAR (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANWAR
Last Name:GHATTAS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 TAPPAHANNOCK BLVD
Mailing Address - Street 2:
Mailing Address - City:TAPPAHANNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22560-9350
Mailing Address - Country:US
Mailing Address - Phone:804-443-4709
Mailing Address - Fax:
Practice Address - Street 1:1840 TAPPAHANNOCK BLVD
Practice Address - Street 2:
Practice Address - City:TAPPAHANNOCK
Practice Address - State:VA
Practice Address - Zip Code:22560-9350
Practice Address - Country:US
Practice Address - Phone:804-443-4709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208232183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist