Provider Demographics
NPI:1093089757
Name:FT BELVOIR HOSPITAL OUTPATIENT PHARMACY
Entity Type:Organization
Organization Name:FT BELVOIR HOSPITAL OUTPATIENT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ABBEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GULELAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-321-3224
Mailing Address - Street 1:7825 GAMBRILL WOODS WAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153-2260
Mailing Address - Country:US
Mailing Address - Phone:703-455-5445
Mailing Address - Fax:
Practice Address - Street 1:9501 FARRELL RD
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5901
Practice Address - Country:US
Practice Address - Phone:571-231-3224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009851282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1234567OtherPHARMACY