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General NPI Number Information
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NPI Number | 1114475118
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Entity Type | Organization
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Legal Business Name | MONUMENT-FAIRFAX, LLC
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Dates
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Enumeration Date | 09/19/2016
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Last Update Date | 10/10/2023
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Provider Practice Location Address
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Address Line | 11230 WAPLES MILL RD STE 115
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City | FAIRFAX
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State | VA
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Zip | 22030-5026
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Country | US
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Telephone | 703-899-5947
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Fax | 703-272-7497
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Provider Business Mailing Address
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Address Line | 11230 WAPLES MILL RD STE 115
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City | FAIRFAX
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State | VA
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Zip | 22030-5026
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Country | US
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Telephone | 703-899-5947
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Fax |
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Authorized Official
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Title or Position | COO
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Name | PATRICK F DOWNING
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Credential |
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Telephone | 508-654-6577
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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 | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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