Provider Demographics
NPI:1588081020
Name:MILLENNIUM PHARMACY
Entity type:Organization
Organization Name:MILLENNIUM PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER/PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDALLA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:571-271-5019
Mailing Address - Street 1:6305 CASTLE PL STE 1E
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-1905
Mailing Address - Country:US
Mailing Address - Phone:703-992-8686
Mailing Address - Fax:703-992-8766
Practice Address - Street 1:6305 CASTLE PL STE 1E
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-1905
Practice Address - Country:US
Practice Address - Phone:703-992-8686
Practice Address - Fax:703-992-8766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-22
Last Update Date:2014-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy