Provider Demographics
NPI:1174151716
Name:VANDORN PHARMACY INC
Entity type:Organization
Organization Name:VANDORN PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YODIT
Authorized Official - Middle Name:
Authorized Official - Last Name:GULELAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-348-7186
Mailing Address - Street 1:5724 EDSALL RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-4712
Mailing Address - Country:US
Mailing Address - Phone:202-765-6110
Mailing Address - Fax:703-348-8470
Practice Address - Street 1:5724 EDSALL RD ALEXANDRIA VA 22304
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-4712
Practice Address - Country:US
Practice Address - Phone:202-765-6110
Practice Address - Fax:703-348-8470
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VANDORN PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-30
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy