Provider Demographics
NPI:1104485473
Name:MEDPLUS PHARMACY 3
Entity type:Organization
Organization Name:MEDPLUS PHARMACY 3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HUSSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-ATAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-641-2221
Mailing Address - Street 1:8609 SUDLEY RD STE 103B
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4500
Mailing Address - Country:US
Mailing Address - Phone:281-800-8480
Mailing Address - Fax:
Practice Address - Street 1:5150 CRENSHAW RD STE 9
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3094
Practice Address - Country:US
Practice Address - Phone:281-800-8480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336S0011XSuppliersPharmacySpecialty Pharmacy