Organization
PROSPERITY PRINCE WILLIAM RX INC
Active
Other names
Prosperity Pharmacy Manassas
Organization subpart
No
Provider details
NPI number
Authorized official
FRANK ODEH RPH (PRESIDENT)
(571) 730-1130
Entity
Organization
Contact information
Practice address
8644 SUDLEY RD, SUITE 120, MANASSAS, VA 20110-4417
(703) 334-5180
(703) 334-5184
Mailing address
8644 SUDLEY RD, SUITE 120, MANASSAS, VA 20110-4417
(703) 334-5180
(703) 334-5184
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0201004275
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801035548
—
VA
01
—
2118235
PK
—
Enumeration date
02/19/2009
Last updated
04/24/2017
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