Provider Demographics
NPI:1841760048
Name:FAGHRI, ROUDABEH (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ROUDABEH
Middle Name:
Last Name:FAGHRI
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 DUTCHMANS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:MD
Mailing Address - Zip Code:21716-9770
Mailing Address - Country:US
Mailing Address - Phone:301-834-4805
Mailing Address - Fax:301-834-4809
Practice Address - Street 1:1201 DUTCHMANS CREEK DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:MD
Practice Address - Zip Code:21716-9770
Practice Address - Country:US
Practice Address - Phone:301-834-4805
Practice Address - Fax:301-834-4809
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251731835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist