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General NPI Number Information
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NPI Number | 1144041690
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Entity Type | Organization
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Legal Business Name | KING STREET APOTHECARY
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 4680 KING ST
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City | ALEXANDRIA
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State | VA
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Zip | 22302-1215
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Country | US
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Telephone | 703-879-3477
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Fax | 703-512-4110
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Provider Business Mailing Address
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Address Line | 4680 KING ST
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City | ALEXANDRIA
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State | VA
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Zip | 22302-1215
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Country | US
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Telephone | 703-879-3477
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Fax | 703-512-4110
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Authorized Official
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Title or Position | OWNER/PIC
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Name | DR. BENYAM MITIKU
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Credential | PHARMD
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Telephone | 703-879-3477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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