Provider Demographics
NPI:1790388684
Name:RAGHEB, MARIAM (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:RAGHEB
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 KING ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-3103
Mailing Address - Country:US
Mailing Address - Phone:703-548-8357
Mailing Address - Fax:703-548-5074
Practice Address - Street 1:503 KING ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-3103
Practice Address - Country:US
Practice Address - Phone:703-548-8357
Practice Address - Fax:703-548-5074
Is Sole Proprietor?:No
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist