Provider Demographics
NPI:1578040176
Name:FAIRFAX STATION PHARMACY
Entity type:Organization
Organization Name:FAIRFAX STATION PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HANY
Authorized Official - Middle Name:
Authorized Official - Last Name:FARAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-495-3410
Mailing Address - Street 1:5616G OX RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-1018
Mailing Address - Country:US
Mailing Address - Phone:703-495-3410
Mailing Address - Fax:703-995-0756
Practice Address - Street 1:5616G OX RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX STATION
Practice Address - State:VA
Practice Address - Zip Code:22039-1018
Practice Address - Country:US
Practice Address - Phone:703-495-3410
Practice Address - Fax:703-995-0756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy