=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740959899
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMMAR ALSUKAIRI PHARMACIST
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2021
-----------------------------------------------------
Last Update Date | 09/11/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4300 BACKLICK RD
-----------------------------------------------------
City | ANNANDALE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22003-3142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-813-6050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6594 FOREST DEW CT
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22152-2162
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-253-9416
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PH100004197
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------