Potomac Health Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

0201004336 Issued in VA

Legal business name

POTOMAC HEALTH PHARMACY LLC

Practice address

1900 Opitz Blvd
Ste B
Woodbridge, VA 22191-3320

Phone

(703) 291-0417

NPI assigned

Mar 22, 2010

Organization subpart

No

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

Authorized official

Name

Azam Rahimi

Title

Owner

Phone

(917) 595-9610

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Potomac Health Pharmacy Doing business as

Locations

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

{
    "created_epoch": "1269216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277337600000",
    "number": "1982928750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8142 GILROY DR",
            "city": "LORTON",
            "state": "VA",
            "postal_code": "220792936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 OPITZ BLVD",
            "address_2": "STE B",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221913320",
            "telephone_number": "703-291-0417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTOMAC HEALTH PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-22",
        "last_updated": "2010-06-24",
        "status": "A",
        "authorized_official_last_name": "RAHIMI",
        "authorized_official_first_name": "AZAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "917-595-9610"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "VA",
            "license": "0201004336",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "4842173",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Potomac Health Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Community/Retail Pharmacy in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2010; 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.