Provider Information for 1699929075
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WOODBRIDGE PHARMACY
Other Names:Doing Business As:WOODBRIDGE PHARMACYOrganization Subpart: NO
NPI: 1699929075
Last Updated: 2010-02-10
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1699929075 | ||||||||||||
| Enumeration Date | 2008-11-11 | ||||||||||||
| NPI Type | NPI-2 Organization | ||||||||||||
| Status | Active | ||||||||||||
| Authorized Official Information | Name: Mr. THOMAS MOORE Title: PIC Phone: 7034916802 | ||||||||||||
| Mailing Address | 14904 JEFFERSON DAVIS HWY SUITE 206 WOODBRIDGE, VA 22191-3908 United States Phone: 703-491-6802 | Fax:703-491-6804 | ||||||||||||
| Primary Practice Address | 14904 JEFFERSON DAVIS HWY SUITE 206 WOODBRIDGE, VA 22191-3908 United States Phone: 703-491-6802 | Fax:703-491-6804 | ||||||||||||
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