Provider Demographics
NPI:1932206778
Name:VIENNA DRUG CENTER INC
Entity Type:Organization
Organization Name:VIENNA DRUG CENTER INC
Other - Org Name:VIENNA DRUG CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BORGATTI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:703-938-7111
Mailing Address - Street 1:150 MAPLE AVE W
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-5727
Mailing Address - Country:US
Mailing Address - Phone:703-938-7111
Mailing Address - Fax:703-938-5242
Practice Address - Street 1:150 MAPLE AVE W
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-5727
Practice Address - Country:US
Practice Address - Phone:703-938-7111
Practice Address - Fax:703-938-5242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010008383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8501122Medicaid
2102091OtherPK
VA8501122Medicaid