Provider Demographics
NPI:1548693922
Name:NORTHERN VA COMPOUNDERS PLLC
Entity type:Organization
Organization Name:NORTHERN VA COMPOUNDERS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BASSEM
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRGIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:908-421-3738
Mailing Address - Street 1:23475 ROCK HAVEN WAY STE 105
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-4477
Mailing Address - Country:US
Mailing Address - Phone:571-267-5050
Mailing Address - Fax:
Practice Address - Street 1:23475 ROCK HAVEN WAY STE 105
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-4477
Practice Address - Country:US
Practice Address - Phone:571-267-5050
Practice Address - Fax:571-267-5051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy