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General NPI Number Information
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NPI Number | 1013356427
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Entity Type | Organization
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Legal Business Name | LANDMARK PROFESSIONAL PHARMACY,LLC
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Dates
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Enumeration Date | 06/19/2013
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 5249 DUKE ST UNIT LL
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City | ALEXANDRIA
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State | VA
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Zip | 22304-2926
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Country | US
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Telephone | 703-212-0200
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Fax | 703-212-0202
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Provider Business Mailing Address
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Address Line | 5249 DUKE ST UNIT LL
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City | ALEXANDRIA
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State | VA
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Zip | 22304-2926
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Country | US
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Telephone | 703-212-0200
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Fax | 703-212-0202
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | ELIAS AMBAYE
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Credential | PHARMD
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Telephone | 703-585-3059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 0201004527
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License Number State | VA
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