Active NPI
St Theodore LLC
Doing business as Ted Pharmacy
- Long Term Care Pharmacy
- Aldie, VA
National Provider Identifier
1710618129
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Long Term Care Pharmacy
- Legal business name
- ST THEODORE LLC
- Doing business as
- Ted Pharmacy
- Practice address
- 24585 Stone Carver Dr Ste 175
Aldie, VA 20105-3255 - Phone
- (571) 367-3914
- NPI assigned
- Jun 17, 2022
- Last updated
- Mar 29, 2023
- Organization subpart
- Yes
- Parent organization
- -
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ehab Tadrous
- Title
- Pharmacist in Charge
- Phone
- (571) 367-3914
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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Long Term Care Pharmacy | 3336L0003X | NU | Primary |
Addresses
Primary practice location
24585 Stone Carver Dr Ste 175
Aldie, VA 20105-3255
Mailing address
24585 Stone Carver Dr Ste 175
Aldie, VA 20105-3255
Phone (571) 367-3914
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659860500 | Medicaid | VA |
Other names 1
- TED PHARMACY
National Provider Directory
National Provider Directory- Part of
- St Theodore LLC
Practitioners & affiliated clinicians
Practitioners 2
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.
-
- Pharmacist
- Aldie, VA
- NPI 1376138503
-
- Community/Retail Pharmacy
- Aldie, VA
- NPI 1386119774
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1655424000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1680048000000",
"number": "1710618129",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24585 STONE CARVER DR STE 175",
"city": "ALDIE",
"state": "VA",
"postal_code": "201053255",
"telephone_number": "571-367-3914"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24585 STONE CARVER DR STE 175",
"city": "ALDIE",
"state": "VA",
"postal_code": "201053255",
"telephone_number": "571-367-3914"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ST THEODORE LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "-",
"enumeration_date": "2022-06-17",
"last_updated": "2023-03-29",
"certification_date": "2023-03-29",
"status": "A",
"authorized_official_last_name": "TADROUS",
"authorized_official_first_name": "EHAB",
"authorized_official_title_or_position": "PHARMACIST IN CHARGE",
"authorized_official_telephone_number": "571-367-3914"
},
"taxonomies": [
{
"code": "3336L0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Long Term Care Pharmacy",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1659860500",
"state": "VA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "TED PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Aldie, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 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.