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Organization
ST THEODORE LLC
Active
Organization
ST THEODORE LLC
Active
Parent organization
-
Other names
TED PHARMACY
Organization subpart
Yes
Provider details
NPI number
Legal business name
-
Authorized official
EHAB TADROUS (PHARMACIST IN CHARGE)
(571) 367-3914
Entity
Organization
Contact information
Practice address
24585 STONE CARVER DR STE 175, ALDIE, VA 20105-3255
(571) 367-3914
Mailing address
24585 STONE CARVER DR STE 175, ALDIE, VA 20105-3255
(571) 367-3914
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659860500
—
VA
Enumeration date
06/17/2022
Last updated
03/29/2023
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