Provider Demographics
NPI:1760149611
Name:FARAG, HANAA TALAT
Entity Type:Individual
Prefix:
First Name:HANAA
Middle Name:TALAT
Last Name:FARAG
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:PO BOX 4035
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22194-4035
Mailing Address - Country:US
Mailing Address - Phone:703-851-6677
Mailing Address - Fax:
Practice Address - Street 1:18039 DUMFRIES SHOPPING PLZ
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026-2356
Practice Address - Country:US
Practice Address - Phone:703-221-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-25
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202220001183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist