Provider Demographics
NPI:1922610690
Name:ATASHJOO, SAMIRA (RPH)
Entity Type:Individual
Prefix:
First Name:SAMIRA
Middle Name:
Last Name:ATASHJOO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11615 SUMMER OAK DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1937
Mailing Address - Country:US
Mailing Address - Phone:301-509-7179
Mailing Address - Fax:
Practice Address - Street 1:229 KENTLANDS BLVD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-5446
Practice Address - Country:US
Practice Address - Phone:301-208-8203
Practice Address - Fax:301-972-2539
Is Sole Proprietor?:No
Enumeration Date:2020-08-23
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist