Provider Demographics
NPI:1740679265
Name:ZAMANI, SHAHLA
Entity type:Individual
Prefix:
First Name:SHAHLA
Middle Name:
Last Name:ZAMANI
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 1:46380 MONOCACY SQ
Mailing Address - Street 2:
Mailing Address - City:POTOMAC FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:20165-7255
Mailing Address - Country:US
Mailing Address - Phone:703-774-7579
Mailing Address - Fax:
Practice Address - Street 1:46380 MONOCACY SQUARE
Practice Address - Street 2:
Practice Address - City:POTOMAC FALLS
Practice Address - State:VA
Practice Address - Zip Code:20165
Practice Address - Country:US
Practice Address - Phone:703-774-7579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202012389183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist