Provider Demographics
NPI:1972854479
Name:ISAYAS, MINIA
Entity Type:Individual
Prefix:
First Name:MINIA
Middle Name:
Last Name:ISAYAS
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 1:20070 ASHBROOK COMMONS PLZ
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5034
Mailing Address - Country:US
Mailing Address - Phone:571-223-0517
Mailing Address - Fax:571-223-0542
Practice Address - Street 1:20070 ASHBROOK COMMONS PLZ
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5034
Practice Address - Country:US
Practice Address - Phone:571-223-0517
Practice Address - Fax:571-223-0542
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205620183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist