Vitto Amnathvong, PHARMD

Key facts

NPI

1447884184

Entity type

Individual (NPI type 1)

Primary specialty

Pharmacist 183500000X

License

0202214237 (VA)

Practice address

19500 Sandridge Way Ste 140
Leesburg, VA 20176-3689

Phone

(571) 440-2401

Fax

(571) 440-2405

NPI assigned

Mar 2, 2020

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Doctor of Pharmacy

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 2, 2020.

{
    "created_epoch": "1583107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583107200000",
    "number": "1447884184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8817 SYLVANIA ST",
            "city": "LORTON",
            "state": "VA",
            "postal_code": "220791612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19500 SANDRIDGE WAY STE 140",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201763689",
            "telephone_number": "571-440-2401",
            "fax_number": "571-440-2405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMNATHVONG",
        "first_name": "VITTO",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-02",
        "last_updated": "2020-03-02",
        "certification_date": "2020-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "VA",
            "license": "0202214237",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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