Provider Demographics
NPI:1992453237
Name:AL-ZUHAIRI, SURA M
Entity type:Individual
Prefix:
First Name:SURA
Middle Name:M
Last Name:AL-ZUHAIRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25815 MEWS TER
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-6360
Mailing Address - Country:US
Mailing Address - Phone:317-989-4107
Mailing Address - Fax:
Practice Address - Street 1:25815 MEWS TER
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-6360
Practice Address - Country:US
Practice Address - Phone:317-989-4107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202220050183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist