Provider Demographics
NPI:1639985351
Name:IJAZ, JANNAT (PHARMD)
Entity type:Individual
Prefix:
First Name:JANNAT
Middle Name:
Last Name:IJAZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 LAUREL WAY APT 2B
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4432
Mailing Address - Country:US
Mailing Address - Phone:571-653-0565
Mailing Address - Fax:
Practice Address - Street 1:7500 CENTREVILLE RD
Practice Address - Street 2:
Practice Address - City:MANASSAS PARK
Practice Address - State:VA
Practice Address - Zip Code:20111-1743
Practice Address - Country:US
Practice Address - Phone:703-369-1920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2024-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202222489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist