Organization
KC PHARMACY LLC
Active
Other names
KC PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
FARHAD MOALEM MSME (PRESIDENT OWNER)
(703) 339-9599
Entity
Organization
Contact information
Practice address
8988 LORTON STATION BLVD, 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
3336C0003X
Community/Retail Pharmacy
Primary
0201004087
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010275776
—
VA
01
—
4839328
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/18/2006
Last updated
02/08/2012
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