Provider Demographics
NPI:1780426148
Name:AL-OBAIDI, REEM
Entity type:Individual
Prefix:
First Name:REEM
Middle Name:
Last Name:AL-OBAIDI
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 1:4201 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-1126
Mailing Address - Country:US
Mailing Address - Phone:703-344-6797
Mailing Address - Fax:
Practice Address - Street 1:2200 TACKETTS MILL DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-3012
Practice Address - Country:US
Practice Address - Phone:703-494-9108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202221062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist