Provider Demographics
NPI:1568629251
Name:CULMORE DRUG STORE
Entity Type:Organization
Organization Name:CULMORE DRUG STORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:VAN
Authorized Official - Middle Name:VIEN
Authorized Official - Last Name:GIANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-636-6806
Mailing Address - Street 1:6003 LEESBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041
Mailing Address - Country:US
Mailing Address - Phone:703-931-0288
Mailing Address - Fax:703-931-0879
Practice Address - Street 1:6003 LEESBURG PIKE
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-2237
Practice Address - Country:US
Practice Address - Phone:703-931-0288
Practice Address - Fax:703-931-0879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010042203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy