# MONUMENT-FAIRFAX, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Revolution Meds Pharmacy, Revolution Meds Pharmacy, INC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114475118
- **Authorized official:** PATRICK F DOWNING (COO)
- **Authorized official phone:** (508) 654-6577

## Contact information

- **Practice address:** 11230 WAPLES MILL RD STE 115, FAIRFAX, VA 22030-5026
- **Practice address phone:** (703) 899-5947
- **Practice address fax:** (703) 272-7497
- **Mailing address:** 11230 WAPLES MILL RD STE 115, FAIRFAX, VA 22030-5026
- **Mailing address phone:** (703) 899-5947

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 09/19/2016
- **Last updated:** 10/10/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2164585 | PK | — |