Healthcare Provider Details

I. General information

NPI: 1588286876
Provider Name (Legal Business Name): VAN NESS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4215 CONNECTICUT AVE NW # 1
WASHINGTON DC
20008-1159
US

IV. Provider business mailing address

4215 CONNECTICUT AVE NW STE 1 STE 1
WASHINGTON DC
20008-1159
US

V. Phone/Fax

Practice location:
  • Phone: 202-244-7979
  • Fax: 202-244-7977
Mailing address:
  • Phone: 202-244-7979
  • Fax: 202-244-7977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GEORGE NADER BISHAY MARCOS
Title or Position: PIC AND OWNER
Credential:
Phone: 202-244-7979