Healthcare Provider Details

I. General information

NPI: 1962873695
Provider Name (Legal Business Name): PROCARE PHARMACY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7202 POPLAR ST STE E
ANNANDALE VA
22003-3025
US

IV. Provider business mailing address

7202 POPLAR ST
ANNANDALE VA
22003-3025
US

V. Phone/Fax

Practice location:
  • Phone: 571-830-6583
  • Fax: 571-830-6923
Mailing address:
  • Phone: 571-830-6583
  • Fax: 571-830-6923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0201004684
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBYN DOAN
Title or Position: MANAGER
Credential:
Phone: 571-830-6583