Provider Demographics
NPI:1912206160
Name:AMIN, BESHOUI W (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:BESHOUI
Middle Name:W
Last Name:AMIN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12890 TOUCHSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-7648
Mailing Address - Country:US
Mailing Address - Phone:703-590-0643
Mailing Address - Fax:
Practice Address - Street 1:12890 TOUCHSTONE CIR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-7648
Practice Address - Country:US
Practice Address - Phone:703-590-0643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-26
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist