Provider Demographics
NPI:1518455997
Name:MEDPLUS PHARMACY 2 LLC
Entity Type:Organization
Organization Name:MEDPLUS PHARMACY 2 LLC
Other - Org Name:MEDPLUS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUSSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-ATAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-641-2221
Mailing Address - Street 1:8609 SUDLEY RD STE 103B
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4500
Mailing Address - Country:US
Mailing Address - Phone:202-641-2221
Mailing Address - Fax:
Practice Address - Street 1:8609 SUDLEY RD STE 103B
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4500
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:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy