1053718924 NPI number — FAMILY PHARMACY, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053718924 NPI number — FAMILY PHARMACY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY PHARMACY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053718924
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10132 COLVIN RUN RD STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREAT FALLS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22066-1840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-762-6220
Provider Business Mailing Address Fax Number:
571-316-1385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10721 MAIN ST
Provider Second Line Business Practice Location Address:
107
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22030-6914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-340-3355
Provider Business Practice Location Address Fax Number:
571-316-1545
Provider Enumeration Date:
11/20/2014

Additional Information

Authorized Official

Authorized Official Last Name:
HAMDY
Authorized Official First Name:
KAREEM
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
703-762-6220

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  0201004618 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0201004618 . This is a "VIRGINIA BOARD OF PHARMACY" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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