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General NPI Number Information
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NPI Number | 1871852848
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Entity Type | Organization
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Legal Business Name | GAINESVILLE PHARMACY LLC
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Dates
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Enumeration Date | 05/11/2012
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Last Update Date | 05/11/2012
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Provider Practice Location Address
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Address Line | 7963 HERITAGE VILLAGE PLAZA
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City | GAINESVILLE
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State | VA
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Zip | 20155
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Country | US
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Telephone | 703-909-8495
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Fax | 703-425-2052
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Provider Business Mailing Address
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Address Line | 7963 HERITAGE PLAZA
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City | GAINESVILLE
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State | VA
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Zip | 20155
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Country | US
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Telephone | 703-909-8495
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Fax | 703-425-2052
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Authorized Official
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Title or Position | PHARMACIST-IN-CHARGE
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Name | MRS. FERESHTEH EJTEMAI
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Credential |
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Telephone | 703-909-8495
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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 |
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License Number State | VA
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