Provider Demographics
NPI:1043979081
Name:ALEXANDRIA COMPOUNDING PHARMACY
Entity Type:Organization
Organization Name:ALEXANDRIA COMPOUNDING PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FEDAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOABDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-290-1785
Mailing Address - Street 1:9868 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3908
Mailing Address - Country:US
Mailing Address - Phone:703-549-4350
Mailing Address - Fax:703-683-1039
Practice Address - Street 1:9868 MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3908
Practice Address - Country:US
Practice Address - Phone:703-549-4350
Practice Address - Fax:703-683-1039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-16
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy