Provider Demographics
NPI:1508143959
Name:NORTH COUNTY HEALTH CENTER
Entity Type:Organization
Organization Name:NORTH COUNTY HEALTH CENTER
Other - Org Name:NORTH COUNTY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHCN DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:KOOROSH
Authorized Official - Middle Name:
Authorized Official - Last Name:JEIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-459-7394
Mailing Address - Street 1:11484 WASHINGTON PLZ W
Mailing Address - Street 2:SUITE #300
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-4344
Mailing Address - Country:US
Mailing Address - Phone:703-787-3217
Mailing Address - Fax:703-481-3853
Practice Address - Street 1:11484 WASHINGTON PLZ W
Practice Address - Street 2:SUITE #300
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-4344
Practice Address - Country:US
Practice Address - Phone:703-787-3217
Practice Address - Fax:703-481-3853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010040603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4843466OtherNCPDP PROVIDER IDENTIFICATION NUMBER