Provider Demographics
NPI:1871139055
Name:HABIB, SANDRA (PHARMACIST)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:HABIB
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 1:20500 HERON OVERLOOK PLZ
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3003
Mailing Address - Country:US
Mailing Address - Phone:571-223-0006
Mailing Address - Fax:
Practice Address - Street 1:20500 HERON OVERLOOK PLZ
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3003
Practice Address - Country:US
Practice Address - Phone:571-223-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022171921835P0018X
MI53020353351835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist