=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114391604
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STONE SPRINGS PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2015
-----------------------------------------------------
Last Update Date | 12/18/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10721 MAIN ST STE 107
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22030-6902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-592-8300
-----------------------------------------------------
Fax | 703-592-8301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24818 WIND RIVER DR
-----------------------------------------------------
City | STONE RIDGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20105-2949
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-966-7853
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | TAHA TOKHI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-966-7853
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 0201004738
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------