Provider Demographics
NPI:1588286876
Name:VAN NESS PHARMACY LLC
Entity type:Organization
Organization Name:VAN NESS PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUC
Authorized Official - Middle Name:
Authorized Official - Last Name:YAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-423-6667
Mailing Address - Street 1:41010 MISTY VALE CIR
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105
Mailing Address - Country:US
Mailing Address - Phone:703-786-8402
Mailing Address - Fax:202-244-7977
Practice Address - Street 1:4215 CONNECTICUT AVE ST #1 NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008
Practice Address - Country:US
Practice Address - Phone:703-786-8402
Practice Address - Fax:202-244-7977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-11
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy