Organization
GDT LLC
Active
Other names
Health Star Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY HALL (ADMINISTRATOR)
(571) 440-2401
Entity
Organization
Contact information
Practice address
19500 SANDRIDGE WAY STE 140, LEESBURG, VA 20176-3689
(571) 440-2401
(571) 440-2405
Mailing address
19500 SANDRIDGE WAY STE 140, LEESBURG, VA 20176-3689
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013555143
—
VA
Enumeration date
12/19/2019
Last updated
03/27/2020
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