Organization
KC PHARMACY HEALTHMART INC
Active
Other names
KC Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
GIHAN SERAKA (MANAGER)
(703) 339-9599
Entity
Organization
Contact information
Practice address
8988 LORTON STATION BLVD, SUITE 102, LORTON, VA 22079-4756
(703) 339-9599
(703) 339-7111
Mailing address
8988 LORTON STATION BLVD, LORTON, VA 22079-4756
(703) 339-9599
(703) 339-7111
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0201004087
VA
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093081028
—
VA
01
—
2134252
PK
—
Enumeration date
03/23/2012
Last updated
08/06/2020
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