Provider Demographics
NPI:1841590643
Name:ANSARI, ROXANA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ROXANA
Middle Name:
Last Name:ANSARI
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 1:19718 GERMANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1204
Mailing Address - Country:US
Mailing Address - Phone:301-916-8587
Mailing Address - Fax:301-916-8597
Practice Address - Street 1:19718 GERMANTOWN RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1204
Practice Address - Country:US
Practice Address - Phone:301-916-8587
Practice Address - Fax:301-916-8597
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18967183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist