NPIMap

Organization Active NPI

Broad Street Pharmacy Inc

Doing business as Broad Street Pharmacy

  • Community/Retail Pharmacy
  • Falls Church, VA
National Provider Identifier
1598933434
Registry record updated May 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
0201004216 Issued in VA
Legal business name
BROAD STREET PHARMACY INC
Doing business as
Broad Street Pharmacy
Practice address
450 W Broad St
Ste 120 B
Falls Church, VA 22046-3340
Phone
(703) 533-9013
Fax
(703) 533-9015
NPI assigned
Feb 13, 2008
Last updated
May 13, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Reza Ghaderi, RPHNPI 1386312387
Title
Owner
Phone
(703) 307-2139

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 0201004216 VA Primary
Specialty Pharmacy 3336S0011X NU
Compounding Pharmacy 3336C0004X NU

Addresses

Primary practice location

450 W Broad St
Ste 120 B
Falls Church, VA 22046-3340

Mailing address

450 W Broad St
Ste 120
Falls Church, VA 22046-3340
Phone (703) 533-9013

Other identifiers 1

IdentifierTypeStateIssuer
2106340OtherPK

Other names 1

  • BROAD STREET PHARMACY Doing business as

National Provider Directory

National Provider Directory

Locations

450 W Broad St
Ste 120
Falls Church, VA 22046

450 W Broad St
Ste 120B
Falls Church, VA 22046
Phone (703) 533-9013

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368403200000",
    "number": "1598933434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 W BROAD ST",
            "address_2": "STE 120",
            "city": "FALLS CHURCH",
            "state": "VA",
            "postal_code": "220463340",
            "telephone_number": "703-533-9013",
            "fax_number": "703-533-9015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 W BROAD ST",
            "address_2": "STE 120 B",
            "city": "FALLS CHURCH",
            "state": "VA",
            "postal_code": "220463340",
            "telephone_number": "703-533-9013",
            "fax_number": "703-533-9015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROAD STREET PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-13",
        "last_updated": "2013-05-13",
        "status": "A",
        "authorized_official_last_name": "GHADERI",
        "authorized_official_first_name": "REZA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-307-2139",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "VA",
            "license": "0201004216",
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2106340",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BROAD STREET PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Falls Church, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.