Healthcare Provider Details

I. General information

NPI: 1316432669
Provider Name (Legal Business Name): DELTA PHARM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 01/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8316 ARLINGTON BLVD STE 100
FAIRFAX VA
22031
US

IV. Provider business mailing address

8316 ARLINGTON BLVD STE 100
FAIRFAX VA
22031-5208
US

V. Phone/Fax

Practice location:
  • Phone: 571-395-4444
  • Fax: 703-712-8869
Mailing address:
  • Phone: 571-395-4444
  • Fax: 703-712-8869

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 Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: EHAB SHAABAN
Title or Position: RPH/OWNER
Credential:
Phone: 571-395-4444