Healthcare Provider Details

I. General information

NPI: 1679185805
Provider Name (Legal Business Name): MICHELLE DARKO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11037 MARSH RD
BEALETON VA
22712-9312
US

IV. Provider business mailing address

10671 SUDLEY MANOR DR
MANASSAS VA
20109-2844
US

V. Phone/Fax

Practice location:
  • Phone: 540-439-9742
  • Fax:
Mailing address:
  • Phone: 703-257-2894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202217174
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: