Healthcare Provider Details

I. General information

NPI: 1184249450
Provider Name (Legal Business Name): MY NEIGHBOR PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46169 WESTLAKE DR STE 130
POTOMAC FALLS VA
20165-5875
US

IV. Provider business mailing address

PO BOX 730
BRASELTON GA
30517-0013
US

V. Phone/Fax

Practice location:
  • Phone: 571-404-0007
  • Fax: 703-563-9601
Mailing address:
  • Phone: 571-404-0007
  • Fax: 703-563-9601

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 Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MOHAMED ZAKARIA
Title or Position: MANAGER
Credential: RPH
Phone: 571-404-0007