Healthcare Provider Details

I. General information

NPI: 1073548160
Provider Name (Legal Business Name): DIRECTOR OF FINANCE-COUNTY OF FAIRFAX VA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 12/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 OLD LEE HIGHWAY
FAIRFAX VA
22030-6903
US

IV. Provider business mailing address

12000 GOVERNMENT CENTER PKWY SUITE 552
FAIRFAX VA
22035-0001
US

V. Phone/Fax

Practice location:
  • Phone: 703-246-7113
  • Fax:
Mailing address:
  • Phone: 703-324-3360
  • Fax: 703-324-4573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number0201001462
License Number StateVA

VIII. Authorized Official

Name: ROSALYN FOROOBAR
Title or Position: DEPUTY DIRECTOR FOR HEALTH SERVICES
Credential:
Phone: 703-246-2411