Healthcare Provider Details

I. General information

NPI: 1467975565
Provider Name (Legal Business Name): TDS HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4215 DALE BLVD
WOODBRIDGE VA
22193-2243
US

IV. Provider business mailing address

4215 DALE BLVD
WOODBRIDGE VA
22193-2243
US

V. Phone/Fax

Practice location:
  • Phone: 703-457-1049
  • Fax: 571-659-9028
Mailing address:
  • Phone: 34-571-0497
  • Fax: 571-659-9028

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

VIII. Authorized Official

Name: STELLA N. KINTU
Title or Position: PHARMACIST
Credential: PHARM D
Phone: 703-878-1837