Provider Demographics
NPI:1659363711
Name:FALLS CHURCH PHARMACY, INC
Entity Type:Organization
Organization Name:FALLS CHURCH PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:THU
Authorized Official - Middle Name:ANH
Authorized Official - Last Name:BUI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:703-237-2182
Mailing Address - Street 1:6795 WILSON BLVD STE 1A
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-3313
Mailing Address - Country:US
Mailing Address - Phone:703-237-2182
Mailing Address - Fax:703-237-0613
Practice Address - Street 1:6795 WILSON BLVD
Practice Address - Street 2:STE 1-A
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-3318
Practice Address - Country:US
Practice Address - Phone:703-237-2182
Practice Address - Fax:703-237-0613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010038333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008519765Medicaid
VA4837398OtherNCPDP NUMBER
VA009120394Medicaid
VA4837398OtherNCPDP NUMBER