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General NPI Number Information
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NPI Number | 1902042054
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Entity Type | Organization
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Legal Business Name | TYSONS PHARMACY INC
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Dates
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Enumeration Date | 12/19/2008
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Last Update Date | 04/05/2017
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Provider Practice Location Address
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Address Line | 110 PLEASANT ST NW UNIT C
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City | VIENNA
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State | VA
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Zip | 22180-4447
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Country | US
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Telephone | 703-992-7083
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Fax | 703-992-7253
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Provider Business Mailing Address
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Address Line | 110 PLEASANT ST NW UNIT C
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City | VIENNA
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State | VA
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Zip | 22180-4447
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Country | US
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Telephone | 703-992-7083
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Fax | 703-992-7253
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Authorized Official
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Title or Position | PRESIDENT/MANAGER
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Name | BIJAN AHMADI
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Credential | RPH
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Telephone | 571-338-3502
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 0201004309
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License Number State | VA
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