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General NPI Number Information
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NPI Number | 1245834654
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Entity Type | Individual
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Provider Name | MAJED BENJELLOUN PHARMACY MANAGER
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Gender | Male
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Dates
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Enumeration Date | 11/25/2020
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Last Update Date | 11/25/2020
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Provider Practice Location Address
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Address Line | 36115 GOODWIN DR
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City | LOCUST GROVE
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State | VA
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Zip | 22508-2029
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Country | US
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Telephone | 202-306-4443
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Fax |
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Provider Business Mailing Address
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Address Line | 400 CAMERON STATION BLVD APT 430
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City | ALEXANDRIA
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State | VA
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Zip | 22304-8232
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Country | US
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Telephone | 202-306-4443
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0202207243
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License Number State | VA
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