MEDICARE: KING STREET APOTHECARY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy

General Provider Information

NPI Number	:	1124871959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KING STREET APOTHECARY INC

Provider Business Mailing Address
First Line	:	4680 KING ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-1215
Country	:	US
Telephone Number	:	703-879-3477
Fax Number	:	703-512-4110

Provider Business Practice Location Address
First Line	:	4680 KING ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-1215
Country	:	US
Telephone Number	:	703-879-3477
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. RAHEL YIRGA
Credential	:	MD
Telephone Number	:	703-879-3477

Provider Enumeration Date	:	04/10/2024
Last Update Date	:	01/30/2026

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Directions to “KING STREET APOTHECARY INC ” Practice Location

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