Organization
JH ORG 07302014
Inactive
Organization
JH ORG 07302014
Inactive
Other names
Smoke 2/6/2024, Smoke 4/30/2024, Smoke Upgrade 09022025, Smoke Test 04/14, Smoke 10/29, Smoke 11/11/2025, test DBA, Smoke 04/04, test, Smoke 7/7, Smoke 05/27, smoke 12/12
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TEST ORG-A II MD (ADMIN)
(555) 111-2222
Entity
Organization
Contact information
Practice address
6801 KENNEDY RD, WARRENTON, VA 20187-3995
(324) 324-3434
Mailing address
13600 UNION CHURCH RD, SUMERDUCK, VA 22742-1942
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
1835C0207X
Compounded Sterile Preparations Pharmacist
—
—
1835E0208X
Emergency Medicine Pharmacist
—
—
1835I0206X
Infectious Diseases Pharmacist
Primary
—
—
1835S0206X
Solid Organ Transplant Pharmacist
—
—
207SG0207X
Medical Biochemical Genetics
—
—
Other
Enumeration date
07/30/2014
Last updated
08/05/2026
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