MEDICARE: SHERWOOD HALL PHARMACY

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	3336C0003X	Community/Retail Pharmacy	0201001508	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4814807	OTHER		NCPDP

General Provider Information

NPI Number	:	1568551273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHERWOOD HALL PHARMACY

Provider Business Mailing Address
First Line	:	2616 SHERWOOD HALL LN STE 100
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-3154
Country	:	US
Telephone Number	:	703-780-4612
Fax Number	:

Provider Business Practice Location Address
First Line	:	2616 SHERWOOD HALL LN STE 100
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-3154
Country	:	US
Telephone Number	:	703-780-4612
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST
Name	:	DAVID G. MARTIN
Credential	:	RPH
Telephone Number	:	703-780-4612

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	08/22/2020

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