Provider Demographics
NPI:1659629269
Name:BERHAN, L
Entity Type:Individual
Prefix:
First Name:L
Middle Name:
Last Name:BERHAN
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 1:1405 S FERN ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-2810
Mailing Address - Country:US
Mailing Address - Phone:703-558-1042
Mailing Address - Fax:703-575-7672
Practice Address - Street 1:2800 SOUTH SHIRLINGTON ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206
Practice Address - Country:US
Practice Address - Phone:703-558-1042
Practice Address - Fax:703-575-7672
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206763183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist