Provider Demographics
NPI:1518635887
Name:LCC PHARMACY
Entity Type:Organization
Organization Name:LCC PHARMACY
Other - Org Name:LCC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:AWUYEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-494-8000
Mailing Address - Street 1:1690 OLD BRIDGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-8006
Mailing Address - Country:US
Mailing Address - Phone:703-494-8000
Mailing Address - Fax:571-572-3647
Practice Address - Street 1:1690 OLD BRIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-8006
Practice Address - Country:US
Practice Address - Phone:703-494-8000
Practice Address - Fax:571-572-3647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-01
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1518635887Medicaid