Provider Demographics
NPI:1124416664
Name:ALEXANDRIA CARE PHARMACY STORE#2
Entity Type:Organization
Organization Name:ALEXANDRIA CARE PHARMACY STORE#2
Other - Org Name:ALEXANDRIA CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NURUDDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOWDHURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-566-0397
Mailing Address - Street 1:611 S CARLIN SPRINGS RD STE 105
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1061
Mailing Address - Country:US
Mailing Address - Phone:703-566-0397
Mailing Address - Fax:703-566-0398
Practice Address - Street 1:611 S CARLIN SPRINGS RD STE 105
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-1061
Practice Address - Country:US
Practice Address - Phone:703-566-0397
Practice Address - Fax:703-566-0398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336L0003X
VA02010046213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149522OtherPK