Healthcare Provider Details

I. General information

NPI: 1417234865
Provider Name (Legal Business Name): BAILEY'S HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6196 ARLINGTON BLVD
FALLS CHURCH VA
22044-2902
US

IV. Provider business mailing address

6196 ARLINGTON BLVD
FALLS CHURCH VA
22044-2902
US

V. Phone/Fax

Practice location:
  • Phone: 703-531-3759
  • Fax: 703-237-9355
Mailing address:
  • Phone: 703-531-3759
  • Fax: 703-237-9355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0201004029
License Number StateVA

VIII. Authorized Official

Name: KOOROSH JEIRAN
Title or Position: CHCN DIRECTOR OF PHARMACY
Credential:
Phone: 703-459-7394