Healthcare Provider Details

I. General information

NPI: 1952095135
Provider Name (Legal Business Name): JH ORG 07302014
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2014
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date: 09/02/2025
Reactivation Date: 09/02/2025

III. Provider practice location address

6801 KENNEDY RD
WARRENTON VA
20187-3995
US

IV. Provider business mailing address

13600 UNION CHURCH RD
SUMERDUCK VA
22742-1942
US

V. Phone/Fax

Practice location:
  • Phone: 324-324-3434
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0207X
TaxonomyMedical Biochemical Genetics
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1835C0207X
TaxonomyCompounded Sterile Preparations Pharmacist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1835E0208X
TaxonomyEmergency Medicine Pharmacist
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code1835I0206X
TaxonomyInfectious Diseases Pharmacist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code1835S0206X
TaxonomySolid Organ Transplant Pharmacist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. TEST ORG-A II
Title or Position: ADMIN
Credential: MD
Phone: 555-111-2222