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Contact Information

NICOLE Y MAHAM
21412 CHICKACOAN TRAIL DR
BROADLANDS, VA20148-4037
 Phone: 703-835-7220
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pharmacist

183500000X
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for NICOLE Y MAHAM · (Female)

NPI # 1033990452
Status Active
Credentials
Entity Individual
Enumeration date 10/11/2023
Last updated 10/08/2024 - More than a year ago
Sole proprietor 1 Yes
Identifiers
  • VA License # 0202221636
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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