Provider Demographics
NPI:1538756473
Name:GIRGIS, MIRA
Entity type:Individual
Prefix:
First Name:MIRA
Middle Name:
Last Name:GIRGIS
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 1:13933 MIDDLE CREEK PL
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-3553
Mailing Address - Country:US
Mailing Address - Phone:201-786-8685
Mailing Address - Fax:
Practice Address - Street 1:1636 BELLE VIEW BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22307-6531
Practice Address - Country:US
Practice Address - Phone:703-768-7044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-27
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist