Provider Demographics
NPI:1063297885
Name:RAZAVI, MAHSA
Entity type:Individual
Prefix:
First Name:MAHSA
Middle Name:
Last Name:RAZAVI
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 1:3451 EMYS PL
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:MD
Mailing Address - Zip Code:21770-8817
Mailing Address - Country:US
Mailing Address - Phone:301-706-3938
Mailing Address - Fax:
Practice Address - Street 1:25 GRAND CORNER AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-7305
Practice Address - Country:US
Practice Address - Phone:301-721-1830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29398183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist