Provider Demographics
NPI:1033536909
Name:REMEDIUM PHARMACY, LLC
Entity Type:Organization
Organization Name:REMEDIUM PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:OSSAMA
Authorized Official - Middle Name:HANNA
Authorized Official - Last Name:NASRALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-743-7605
Mailing Address - Street 1:3957 PENDER DR
Mailing Address - Street 2:SUITE #104
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3957 PENDER DR
Practice Address - Street 2:SUITE #104
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6027
Practice Address - Country:US
Practice Address - Phone:703-743-7605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy