Monument-Fairfax, LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

MONUMENT-FAIRFAX, LLC

Doing business as

Revolution Meds Pharmacy

Practice address

11230 Waples Mill Rd Ste 115
Fairfax, VA 22030-5026

Phone

(703) 272-7040

Fax

(703) 272-7497

NPI assigned

Jun 9, 2020

Last updated

Oct 10, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Patrick F Downing

Title

Coo

Phone

(410) 276-7586

Specialties & licenses 2

Addresses

Other names 2

• Revolution Meds Pharmacy Doing business as
• Revolution Meds Pharmacy, Inc. Former legal business name

Tax ID family

Monument-Fairfax LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Monument-Fairfax, LLC

  dba Revolution Meds Pharmacy

  • Long Term Care Pharmacy
  • Fairfax, VA
  • NPI 1114475118
  NPD tax ID

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

{
    "created_epoch": "1591660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696896000000",
    "number": "1700401452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11230 WAPLES MILL RD STE 115",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220305026",
            "telephone_number": "703-272-7040",
            "fax_number": "703-272-7497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11230 WAPLES MILL RD STE 115",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220305026",
            "telephone_number": "703-272-7040",
            "fax_number": "703-272-7497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONUMENT-FAIRFAX, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-09",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A",
        "authorized_official_last_name": "DOWNING",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "410-276-7586"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revolution Meds Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Revolution Meds Pharmacy, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Alicia Montgomery, DVM
• Joyce L Montgomery, LCSW
• Richard A. Monti Jr., M.D.
• Lino Cueto Montilla, M.D.,F.A.C.O.G.
• Monument-Fairfax, LLC (Revolution Meds Pharmacy)
• Mohammad Moien Monzavi, DDS
• Madisen Brooke Moody, LPC
• Hailey Nicole Mook, PHARMD
• Esther Moon
• Jonathan Moon, OTD

• Long Term Care Pharmacy in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Long Term Care Pharmacy in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2023; 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.