Provider Demographics
NPI:1528669439
Name:NAKBEEN, MARY (PHARMACIST)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:NAKBEEN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41196 CANONGATE DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-7072
Mailing Address - Country:US
Mailing Address - Phone:703-470-7729
Mailing Address - Fax:
Practice Address - Street 1:41196 CANONGATE DR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-7072
Practice Address - Country:US
Practice Address - Phone:703-470-7729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205401183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist