Provider Demographics
NPI:1881982601
Name:SERAKA, GIHAN (RPH)
Entity type:Individual
Prefix:DR
First Name:GIHAN
Middle Name:
Last Name:SERAKA
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 1:8988 LORTON STATION BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-4756
Mailing Address - Country:US
Mailing Address - Phone:703-339-9599
Mailing Address - Fax:703-339-7111
Practice Address - Street 1:8988 LORTON STATION BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-4756
Practice Address - Country:US
Practice Address - Phone:703-339-9599
Practice Address - Fax:703-339-7111
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202204419183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist