Healthcare Provider Details

I. General information

NPI: 1255338778
Provider Name (Legal Business Name): FISHHAT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 OLD DOMINION DR STE C
MC LEAN VA
22102-2034
US

IV. Provider business mailing address

8100 OLD DOMINION DR STE C
MC LEAN VA
22102-2034
US

V. Phone/Fax

Practice location:
  • Phone: 703-827-0990
  • Fax: 703-827-0990
Mailing address:
  • Phone: 703-827-0990
  • Fax: 703-827-0990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202013116
License Number StateVA

VIII. Authorized Official

Name: MR. EDWARD DAVID DANOFF
Title or Position: OWNER, PHARMACIST
Credential: BS PHARM.
Phone: 703-827-0990