Provider Demographics
NPI:1427407527
Name:SUDLEY PHARMACY
Entity Type:Organization
Organization Name:SUDLEY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:HUSSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-ATAT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:202-641-2221
Mailing Address - Street 1:11713 ROBERT E LEE DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-1381
Mailing Address - Country:US
Mailing Address - Phone:202-641-2221
Mailing Address - Fax:
Practice Address - Street 1:8609 SUDLEY RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-8321
Practice Address - Country:US
Practice Address - Phone:202-641-2221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies