Provider Demographics
NPI:1841577475
Name:SAMTANI, KANCHAN (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:KANCHAN
Middle Name:
Last Name:SAMTANI
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 1:3101 JEFFERSON DAVIS HWY
Mailing Address - Street 2:T-1076
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22305-3042
Mailing Address - Country:US
Mailing Address - Phone:703-706-3852
Mailing Address - Fax:703-706-3852
Practice Address - Street 1:3101 JEFFERSON DAVIS HWY
Practice Address - Street 2:T-1076
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22305-3042
Practice Address - Country:US
Practice Address - Phone:703-706-3852
Practice Address - Fax:703-706-3852
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205432183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist