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General NPI Number Information
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NPI Number | 1568629251
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Entity Type | Organization
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Legal Business Name | CULMORE DRUG STORE
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 6003 LEESBURG PIKE
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City | FALLS CHURCH
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State | VA
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Zip | 22041-2237
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Country | US
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Telephone | 703-931-0288
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Fax | 703-931-0879
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Provider Business Mailing Address
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Address Line | 6003 LEESBURG PIKE
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City | FALLS CHURCH
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State | VA
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Zip | 22041
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Country | US
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Telephone | 703-931-0288
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Fax | 703-931-0879
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Authorized Official
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Title or Position | MANAGER
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Name | MR. VAN VIEN GIANG
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Credential |
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Telephone | 757-636-6806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 0201004220
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License Number State | VA
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