Provider Demographics
NPI:1821681313
Name:TAKIEDDIN, NOOR
Entity Type:Individual
Prefix:MISS
First Name:NOOR
Middle Name:
Last Name:TAKIEDDIN
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 1:4668 KEARNS CT
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-6445
Mailing Address - Country:US
Mailing Address - Phone:703-225-9393
Mailing Address - Fax:
Practice Address - Street 1:11620 MONUMENT DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-8706
Practice Address - Country:US
Practice Address - Phone:703-225-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230026980183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician