Organization
VITHALLA, LLC
Active
Other names
Manassas Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KAMINI SHAH MA (OWNER)
(703) 361-1332
Entity
Organization
Contact information
Practice address
8573 SUDLEY RD STE B, MANASSAS, VA 20110-3809
(703) 361-1332
(703) 361-5496
Mailing address
8573 SUDLEY RD STE B, MANASSAS, VA 20110-3809
(703) 361-1332
(703) 361-5496
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
0201002043
VA
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2139157
PK
—
Enumeration date
02/15/2007
Last updated
10/19/2016
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