Organization
AMAVI LLC
Active
Other names
Herndon Pharmacy and Medical Supply
Organization subpart
No
Provider details
NPI number
Authorized official
DIPTESHKUMAR PATEL (PHARMACY MANAGER)
(704) 701-1790
Entity
Organization
Contact information
Practice address
208 ELDEN ST, HERNDON, VA 20170-4877
(703) 481-0123
(703) 481-0127
Mailing address
2454 ACORN HOLLOW LN, 2454 ACORN HOLLOW LANE, HERNDON, VA 20171-3405
(703) 579-5137
(703) 481-0127
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
0201004368
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2133233
PK
—
Enumeration date
05/04/2011
Last updated
10/19/2016
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