Provider Demographics
NPI:1104403161
Name:KRASTEVA, ELENA (RPH)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:KRASTEVA
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 1:3830 LIGHTFOOT ST UNIT 329
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-3020
Mailing Address - Country:US
Mailing Address - Phone:703-582-2938
Mailing Address - Fax:
Practice Address - Street 1:4725 W OX RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6125
Practice Address - Country:US
Practice Address - Phone:703-802-1229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208942183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist