Provider Demographics
NPI:1891418786
Name:RABANI, SHAFAQ NAZ
Entity Type:Individual
Prefix:
First Name:SHAFAQ
Middle Name:NAZ
Last Name:RABANI
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 1:5469 MAPLEDALE PLZ
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-4526
Mailing Address - Country:US
Mailing Address - Phone:703-590-1700
Mailing Address - Fax:
Practice Address - Street 1:5469 MAPLEDALE PLZ
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-4526
Practice Address - Country:US
Practice Address - Phone:703-590-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202220784183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist