Provider Demographics
NPI:1275630014
Name:RISING SUN OF THE NILE INC
Entity Type:Organization
Organization Name:RISING SUN OF THE NILE INC
Other - Org Name:MCLEAN MEDICAL CTR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:TOURKY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:703-356-0356
Mailing Address - Street 1:1515 CHAIN BRIDGE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4451
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1515 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4451
Practice Address - Country:US
Practice Address - Phone:703-356-0356
Practice Address - Fax:703-356-2088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201002033333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4807181OtherOTHER ID NUMBER-COMMERCIAL NUMBER
VA8503389Medicaid