Provider Demographics
NPI:1730673237
Name:REZNIK, RAISA VLADIMIR (MD,DC)
Entity Type:Individual
Prefix:MRS
First Name:RAISA
Middle Name:VLADIMIR
Last Name:REZNIK
Suffix:
Gender:F
Credentials:MD,DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 BIRCHTREE LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-3034
Mailing Address - Country:US
Mailing Address - Phone:301-233-5654
Mailing Address - Fax:
Practice Address - Street 1:6300 COVENTRY WAY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2256
Practice Address - Country:US
Practice Address - Phone:301-868-0157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist