Organization
POTOMAC HEALTH PHARMACY LLC
Active
Other names
Potomac Health Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
AZAM RAHIMI (OWNER)
(917) 595-9610
Entity
Organization
Contact information
Practice address
1900 OPITZ BLVD, STE B, WOODBRIDGE, VA 22191-3320
(703) 291-0417
Mailing address
8142 GILROY DR, LORTON, VA 22079-2936
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
0201004336
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4842173
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/22/2010
Last updated
06/24/2010
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