Provider Demographics
NPI:1588374250
Name:DESSOUKY, AYA (RPH)
Entity type:Individual
Prefix:
First Name:AYA
Middle Name:
Last Name:DESSOUKY
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 1:9545 BLAKE LN APT 204
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-1774
Mailing Address - Country:US
Mailing Address - Phone:804-490-2485
Mailing Address - Fax:
Practice Address - Street 1:13047 FAIR LAKES SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-5179
Practice Address - Country:US
Practice Address - Phone:703-449-8186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202219120183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist