Provider Demographics
NPI:1801195219
Name:MEDEX PHARMACY LLC
Entity type:Organization
Organization Name:MEDEX PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-388-0828
Mailing Address - Street 1:6845 ELM ST STE 105
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3822
Mailing Address - Country:US
Mailing Address - Phone:703-388-0828
Mailing Address - Fax:703-388-0826
Practice Address - Street 1:6845 ELM ST STE 105
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3822
Practice Address - Country:US
Practice Address - Phone:703-388-0828
Practice Address - Fax:703-388-0826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy