Provider Demographics
NPI:1255338778
Name:FISHHAT INC
Entity type:Organization
Organization Name:FISHHAT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DANOFF
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARM
Authorized Official - Phone:703-827-0990
Mailing Address - Street 1:8100 OLD DOMINION DR STE C
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-2034
Mailing Address - Country:US
Mailing Address - Phone:703-827-0990
Mailing Address - Fax:703-827-0990
Practice Address - Street 1:8100 OLD DOMINION DR STE C
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-2034
Practice Address - Country:US
Practice Address - Phone:703-827-0990
Practice Address - Fax:703-827-0990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202013116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010093961Medicaid
VA5489640001Medicare NSC