NPI | 1598933434 |
---|---|
Doing Business As | BROAD STREET PHARMACY |
Entity Type | Organization |
Authorized Contact | REZA GHADERI Owner 703-307-2139 |
Organization Subpart ? | No |
Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: VA 0201004216) |
Additional Taxonomies | 3336S0011X Pharmacy, Specialty Pharmacy |
3336C0004X Pharmacy, Compounding Pharmacy | |
Enumeration Date | 2008-02-13 |
Last Update Date | 2013-05-13 |