# ST THEODORE LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** -
- **Other names:** TED PHARMACY
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1710618129
- **Legal business name:** -
- **Authorized official:** EHAB TADROUS (PHARMACIST IN CHARGE)
- **Authorized official phone:** (571) 367-3914

## Contact information

- **Practice address:** 24585 STONE CARVER DR STE 175, ALDIE, VA 20105-3255
- **Practice address phone:** (571) 367-3914
- **Mailing address:** 24585 STONE CARVER DR STE 175, ALDIE, VA 20105-3255
- **Mailing address phone:** (571) 367-3914

## Taxonomy

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

## Other

- **Enumeration date:** 06/17/2022
- **Last updated:** 03/29/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1659860500 | — | VA |