Provider Demographics
NPI:1588964084
Name:ABISOUROUR, FOUZIA (PHARMD)
Entity type:Individual
Prefix:
First Name:FOUZIA
Middle Name:
Last Name:ABISOUROUR
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 1:9596 OLD KEENE MILL RD
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-4208
Mailing Address - Country:US
Mailing Address - Phone:703-440-1344
Mailing Address - Fax:703-440-1348
Practice Address - Street 1:9596 OLD KEENE MILL RD
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-4208
Practice Address - Country:US
Practice Address - Phone:703-440-1344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-30
Last Update Date:2010-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205079183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist