MEDICARE: MEDEX PHARMACY LLC

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

General Provider Information

NPI Number	:	1801195219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDEX PHARMACY LLC

Provider Business Mailing Address
First Line	:	6845 ELM ST STE 105
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22101-3822
Country	:	US
Telephone Number	:	703-388-0828
Fax Number	:	703-388-0826

Provider Business Practice Location Address
First Line	:	6845 ELM ST STE 105
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22101-3822
Country	:	US
Telephone Number	:	703-388-0828
Fax Number	:	703-388-0826

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	MR. MOHAMED ABDALLA
Credential	:
Telephone Number	:	703-388-0828

Provider Enumeration Date	:	03/24/2011
Last Update Date	:	10/08/2012

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Directions to “MEDEX PHARMACY LLC ” Practice Location

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