Individual
PHU HA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
44045 RIVERSIDE PKWY STE N1112, LEESBURG, VA 20176-5101
(703) 858-6020
(703) 858-6007
Mailing address
44045 RIVERSIDE PKWY STE N1112, LEESBURG, VA 20176-5101
(703) 858-6020
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
0230037623
VA
Other
Enumeration date
04/29/2024
Last updated
04/29/2024
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