Provider Demographics
NPI:1134992639
Name:KHALEGHI, FARAZ (PHARMACIST)
Entity type:Individual
Prefix:
First Name:FARAZ
Middle Name:
Last Name:KHALEGHI
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 1:5865 TRINITY PKWY APT 340
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-2446
Mailing Address - Country:US
Mailing Address - Phone:804-690-9582
Mailing Address - Fax:
Practice Address - Street 1:42015 VILLAGE CENTER PLZ STE 110
Practice Address - Street 2:
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105-3031
Practice Address - Country:US
Practice Address - Phone:703-542-8344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202221708183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist