Healthcare Provider Details

I. General information

NPI: 1326320177
Provider Name (Legal Business Name): MCLEAN PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 CHAIN BRIDGE RD
MC LEAN VA
22101-3902
US

IV. Provider business mailing address

1315 CHAIN BRIDGE RD
MC LEAN VA
22101-3902
US

V. Phone/Fax

Practice location:
  • Phone: 571-488-6030
  • Fax: 571-488-6035
Mailing address:
  • Phone: 571-488-6030
  • Fax: 571-488-6035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateVA

VIII. Authorized Official

Name: JINOUS GRANMAYEH
Title or Position: OWNER/PHARMACIST
Credential: RPH
Phone: 571-488-6030