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General NPI Number Information
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NPI Number | 1467975565
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Entity Type | Organization
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Legal Business Name | TDS HEALTH
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Dates
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Enumeration Date | 07/20/2017
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 4215 DALE BLVD
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City | WOODBRIDGE
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State | VA
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Zip | 22193-2243
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Country | US
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Telephone | 703-457-1049
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Fax | 571-659-9028
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Provider Business Mailing Address
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Address Line | 4215 DALE BLVD
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City | WOODBRIDGE
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State | VA
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Zip | 22193-2243
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Country | US
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Telephone | 34-571-0497
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Fax | 571-659-9028
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Authorized Official
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Title or Position | PHARMACIST
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Name | STELLA N. KINTU
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Credential | PHARM D
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Telephone | 703-878-1837
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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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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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