Provider Demographics
NPI:1679173777
Name:SOLTANIAN, FARSHAD
Entity Type:Individual
Prefix:
First Name:FARSHAD
Middle Name:
Last Name:SOLTANIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11181 LEE HWY
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5004
Mailing Address - Country:US
Mailing Address - Phone:703-995-5068
Mailing Address - Fax:703-995-5068
Practice Address - Street 1:11181 LEE HWY # F
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5004
Practice Address - Country:US
Practice Address - Phone:703-995-5068
Practice Address - Fax:703-995-5068
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist