Provider Demographics
NPI:1194334524
Name:EDMOND, MAYA RACHELLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MAYA
Middle Name:RACHELLE
Last Name:EDMOND
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18442 CATTAIL SPRING DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-6888
Mailing Address - Country:US
Mailing Address - Phone:703-443-2293
Mailing Address - Fax:
Practice Address - Street 1:8095 INNOVATION PARK DR STE 400
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4868
Practice Address - Country:US
Practice Address - Phone:571-472-5160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD268061835P2201X
VA02022187071835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care