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General NPI Number Information
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NPI Number | 1982928750
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Entity Type | Organization
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Legal Business Name | POTOMAC HEALTH PHARMACY LLC
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Dates
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Enumeration Date | 03/22/2010
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Last Update Date | 06/24/2010
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Provider Practice Location Address
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Address Line | 1900 OPITZ BLVD STE B
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3320
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Country | US
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Telephone | 703-291-0417
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Fax |
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Provider Business Mailing Address
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Address Line | 8142 GILROY DR
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City | LORTON
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State | VA
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Zip | 22079-2936
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AZAM RAHIMI
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Credential |
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Telephone | 917-595-9610
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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 | 0201004336
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License Number State | VA
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