Healthcare Provider Details

I. General information

NPI: 1831949924
Provider Name (Legal Business Name): ASHBURN PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43150 BROADLANDS CENTER PLZ STE 150
BROADLANDS VA
20148-3801
US

IV. Provider business mailing address

43150 BROADLANDS CENTER PLZ STE 150
BROADLANDS VA
20148-3801
US

V. Phone/Fax

Practice location:
  • Phone: 571-479-4125
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MOHANAD YOUNES
Title or Position: PHARMACY OWNER/ IN CHARGE
Credential:
Phone: 703-991-3168