Healthcare Provider Details

I. General information

NPI: 1548520612
Provider Name (Legal Business Name): ALPHA CARE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 12/29/2022
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1638 R ST NW STE 1
WASHINGTON DC
20009-6446
US

IV. Provider business mailing address

41010 MISTY VALE CIR
ALDIE VA
20105-2347
US

V. Phone/Fax

Practice location:
  • Phone: 202-265-7979
  • Fax: 202-265-0589
Mailing address:
  • Phone: 703-786-8402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRX1200009
License Number StateWA

VIII. Authorized Official

Name: JAN HERMINA
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 469-667-3352