Provider Demographics
NPI:1972366185
Name:AZHANDEH, AMAD (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMAD
Middle Name:
Last Name:AZHANDEH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 S GLEBE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-2391
Mailing Address - Country:US
Mailing Address - Phone:703-412-9144
Mailing Address - Fax:
Practice Address - Street 1:3600 S GLEBE RD STE 100
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-2391
Practice Address - Country:US
Practice Address - Phone:703-412-9144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202221780183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist