Provider Demographics
NPI:1336420819
Name:ROUGHANI, AHDIEH S (RPH)
Entity Type:Individual
Prefix:
First Name:AHDIEH
Middle Name:S
Last Name:ROUGHANI
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 1:328 HAMMONTON PL
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-6344
Mailing Address - Country:US
Mailing Address - Phone:240-305-6157
Mailing Address - Fax:
Practice Address - Street 1:11215 NEW HAMPSHIRE AVE STE A
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2631
Practice Address - Country:US
Practice Address - Phone:240-305-6157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13146183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist