Provider Demographics
NPI:1902296767
Name:TARGET PHARMACY
Entity Type:Organization
Organization Name:TARGET PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY INTERN
Authorized Official - Prefix:
Authorized Official - First Name:EMERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-246-7829
Mailing Address - Street 1:7701 LAFAYETTE FOREST DR APT 33
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-6309
Mailing Address - Country:US
Mailing Address - Phone:571-246-7829
Mailing Address - Fax:
Practice Address - Street 1:7701 LAFAYETTE FOREST DR APT 33
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-6309
Practice Address - Country:US
Practice Address - Phone:571-246-7829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02030153263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy