Provider Demographics
NPI:1336747997
Name:GUJJA, VEENA
Entity Type:Individual
Prefix:
First Name:VEENA
Middle Name:
Last Name:GUJJA
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 1:24113 COTY CREST CT
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-2495
Mailing Address - Country:US
Mailing Address - Phone:703-298-6436
Mailing Address - Fax:
Practice Address - Street 1:25401 EASTERN MARKETPLACE PLZ STE 150
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-5784
Practice Address - Country:US
Practice Address - Phone:703-722-2126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist