Healthcare Provider Details

I. General information

NPI: 1497042956
Provider Name (Legal Business Name): NOVA PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 05/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6023 WILSON BLVD
ARLINGTON VA
22205-1503
US

IV. Provider business mailing address

6023 WILSON BLVD
ARLINGTON VA
22205-1503
US

V. Phone/Fax

Practice location:
  • Phone: 703-538-5555
  • Fax: 703-538-5557
Mailing address:
  • Phone: 703-538-5555
  • Fax: 703-538-5557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0201004419
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TO-UYEN DO
Title or Position: OWNER,PIC,AO
Credential: PHARMD,RPH
Phone: 703-538-5555