Provider Demographics
NPI:1427473511
Name:GRANMAYEH, JINOUS (RPH)
Entity type:Individual
Prefix:
First Name:JINOUS
Middle Name:
Last Name:GRANMAYEH
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 1:2011 WESTWOOD FOREST DR
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-5053
Mailing Address - Country:US
Mailing Address - Phone:301-332-0234
Mailing Address - Fax:
Practice Address - Street 1:1392 CHAIN BRIDGE RD
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3904
Practice Address - Country:US
Practice Address - Phone:571-488-6030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205024183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist