Healthcare Provider Details

I. General information

NPI: 1326146291
Provider Name (Legal Business Name): FAIRFAX NURSING CENTER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 MAIN ST
FAIRFAX VA
22030-6904
US

IV. Provider business mailing address

10701 MAIN ST
FAIRFAX VA
22030-6904
US

V. Phone/Fax

Practice location:
  • Phone: 703-273-7705
  • Fax: 703-273-2072
Mailing address:
  • Phone: 703-273-7705
  • Fax: 703-273-2072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202011795
License Number StateVA

VIII. Authorized Official

Name: VU NGUYEN
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 703-273-7705