Provider Demographics
NPI:1790052108
Name:FIROUZDEHGHAN, SIMA (PHARM-D)
Entity Type:Individual
Prefix:
First Name:SIMA
Middle Name:
Last Name:FIROUZDEHGHAN
Suffix:
Gender:F
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10301 NEW GUINEA RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-3268
Mailing Address - Country:US
Mailing Address - Phone:703-764-5112
Mailing Address - Fax:703-764-5112
Practice Address - Street 1:10301 NEW GUINEA RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-3268
Practice Address - Country:US
Practice Address - Phone:703-764-5112
Practice Address - Fax:703-764-5112
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist