Provider Demographics
NPI:1083148290
Name:FREDERICKSBURG CITY PHARMACY INC
Entity Type:Organization
Organization Name:FREDERICKSBURG CITY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOGES
Authorized Official - Middle Name:KIFLE
Authorized Official - Last Name:TEKLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:703-772-0773
Mailing Address - Street 1:2567 COWAN BLVD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-8440
Mailing Address - Country:US
Mailing Address - Phone:540-479-1405
Mailing Address - Fax:540-370-8990
Practice Address - Street 1:2567 COWAN BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8440
Practice Address - Country:US
Practice Address - Phone:540-479-1405
Practice Address - Fax:540-370-8990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010044603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy