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General NPI Number Information
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NPI Number | 1730471186
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Entity Type | Organization
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Legal Business Name | AMAVI LLC
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Dates
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Enumeration Date | 05/04/2011
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 208 ELDEN ST
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City | HERNDON
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State | VA
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Zip | 20170-4877
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Country | US
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Telephone | 703-481-0123
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Fax | 703-481-0127
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Provider Business Mailing Address
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Address Line | 2454 ACORN HOLLOW LN 2454 ACORN HOLLOW LANE
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City | HERNDON
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State | VA
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Zip | 20171-3405
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Country | US
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Telephone | 703-579-5137
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Fax | 703-481-0127
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | DIPTESHKUMAR PATEL
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Credential |
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Telephone | 704-701-1790
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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 | 0201004368
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License Number State | VA
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