MEDICARE: FISHHAT 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	183500000X	Pharmacist	0202013116	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255338778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FISHHAT INC

Provider Business Mailing Address
First Line	:	8100 OLD DOMINION DR STE C
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22102-2034
Country	:	US
Telephone Number	:	703-827-0990
Fax Number	:	703-827-0990

Provider Business Practice Location Address
First Line	:	8100 OLD DOMINION DR STE C
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22102-2034
Country	:	US
Telephone Number	:	703-827-0990
Fax Number	:	703-827-0990

Authorized Official
Title or Position	:	OWNER, PHARMACIST
Name	:	MR. EDWARD DAVID DANOFF
Credential	:	BS PHARM.
Telephone Number	:	703-827-0990

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	07/15/2021

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Directions to “FISHHAT INC ” Practice Location

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