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General NPI Number Information
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NPI Number | 1760596753
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Entity Type | Organization
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Legal Business Name | KC PHARMACY LLC
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 02/08/2012
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Provider Practice Location Address
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Address Line | 8988 LORTON STATION BLVD
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City | LORTON
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State | VA
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Zip | 22079-4756
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Country | US
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Telephone | 703-339-9599
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Fax | 703-339-7111
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Provider Business Mailing Address
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Address Line | 8988 LORTON STATION BLVD
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City | LORTON
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State | VA
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Zip | 22079-4756
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Country | US
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Telephone | 703-339-9599
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Fax | 703-339-7111
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | FARHAD MOALEM
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Credential | MSME
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Telephone | 703-339-9599
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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 | 0201004087
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License Number State | VA
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