Provider Demographics
NPI:1508624909
Name:PARKVIEW NORTH VIRGINIA RX, LLC
Entity Type:Organization
Organization Name:PARKVIEW NORTH VIRGINIA RX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WACLAWEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-876-2323
Mailing Address - Street 1:3920 MAIN ST # 100
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3350
Mailing Address - Country:US
Mailing Address - Phone:716-876-2323
Mailing Address - Fax:
Practice Address - Street 1:11230 WAPLES MILL RD STE 115
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5026
Practice Address - Country:US
Practice Address - Phone:703-272-7040
Practice Address - Fax:703-272-7497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy