Provider Demographics
NPI:1982480471
Name:ANWAR, ALI
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:ANWAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 FAIRFAX TOWNE CTR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2877
Mailing Address - Country:US
Mailing Address - Phone:703-359-0525
Mailing Address - Fax:
Practice Address - Street 1:12200 FAIRFAX TOWNE CTR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2877
Practice Address - Country:US
Practice Address - Phone:703-359-0525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202221527183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist