Provider Demographics
NPI:1639773906
Name:AL-MTWALI, FARAH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:FARAH
Middle Name:
Last Name:AL-MTWALI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7205 LITTLE RIVER TPKE
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3304
Mailing Address - Country:US
Mailing Address - Phone:703-256-4030
Mailing Address - Fax:
Practice Address - Street 1:7205 LITTLE RIVER TPKE
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3304
Practice Address - Country:US
Practice Address - Phone:703-256-4030
Practice Address - Fax:703-916-8945
Is Sole Proprietor?:No
Enumeration Date:2020-11-26
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208082183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist