NPIMap

Organization Active NPI

My Dr's Pharmacy

  • Community/Retail Pharmacy
  • Herndon, VA
National Provider Identifier
1629426648
Registry record updated Sep 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
0201004708 Issued in VA
Legal business name
MY DR'S PHARMACY
Doing business as
My Dr's Pharmacy
Practice address
492 Elden St
Herndon, VA 20170-4513
Phone
(703) 215-8000
Fax
(703) 955-7558
NPI assigned
May 31, 2016
Last updated
Sep 19, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2023

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

Authorized official

Name
Jamil Manna, RPHNPI 1720416027
Title
Owner, Pic, Ao
Phone
(703) 215-8000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Pharmacy 333600000X
Clinic Pharmacy 3336C0002X
Community/Retail Pharmacy 3336C0003X 0201004708 VA Primary

Addresses

Primary practice location

492 Elden St
Herndon, VA 20170-4513

Mailing address

492 Elden St
Herndon, VA 20170-4513
Phone (703) 215-8000

Other identifiers 2

IdentifierTypeStateIssuer
1629426648MedicaidVA
2160792OtherPK

Other names 1

  • My Dr's Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20200610002445 DC Part B Supplier - Pharmacy 4082970272 Practice locations: Herndon, VA
O20231019003632 DC Part B Supplier - Independent Clinical Laboratory 4082970272 Practice locations: Herndon, VA
O20231205000199 VA Part B Supplier - Pharmacy 4082970272 Practice locations: Leesburg, VA

National Provider Directory

National Provider Directory

Locations

412 Elden St
Herndon, VA 20170
Phone (703) 215-8000

Practitioners & affiliated clinicians

Practitioners 4

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": "1464652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695081600000",
    "number": "1629426648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "492 ELDEN ST",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201704513",
            "telephone_number": "703-215-8000",
            "fax_number": "703-955-7558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "492 ELDEN ST",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201704513",
            "telephone_number": "703-215-8000",
            "fax_number": "703-955-7558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY DR'S PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-31",
        "last_updated": "2023-09-19",
        "certification_date": "2023-09-19",
        "status": "A",
        "authorized_official_last_name": "MANNA",
        "authorized_official_first_name": "JAMIL",
        "authorized_official_title_or_position": "OWNER, PIC, AO",
        "authorized_official_telephone_number": "703-215-8000",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "VA",
            "license": "0201004708",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1629426648",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2160792",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "My Dr's Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Herndon, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.