Organization
TARGET
Active
Organization
TARGET
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ADAM KOWALCZYK (PHARMACIST)
(716) 432-5372
Entity
Organization
Contact information
Practice address
14391 CHANTILLY CROSSING LANE, CHANTILLY, VA 20151
(571) 262-0021
(571) 306-5082
Mailing address
14391 CHANTILLY CROSSING LANE, CHANTILLY, VA 20151
(571) 262-0021
(571) 306-5082
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
0202214327
VA
Other
Enumeration date
08/19/2015
Last updated
08/19/2015
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