REVOLUTION MEDS PHARMACY INC (NPI# 1700401452) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700401452 |
| Entity Type | Organization |
| Organization Name | REVOLUTION MEDS PHARMACY INC |
| Practice Address |
11230 Waples Mill Rd Ste 115 Fairfax VA 22030-5026 |
| Practice Telephone | 7032727040 |
| Practice Fax Number | 7032727497 |
| Mailing Telephone | 7032727040 |
| Mailing Fax Number | 7032727497 |
| Enumeration Date | 2020-06-09 |
| Last Update Date | 2020-06-09 |
| Authorized Official Name | JOHN JACOUB (PRESIDENT) |
| Authorized Official Telephone | 7032727040 |
| Authorized Official Credential | PHARMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
Suppliers | ||
| Y | 333600000X | Pharmacy | Suppliers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114475118 | Revolution Meds Pharmacy Inc | Pharmacy | 11230 Waples Mill Rd Ste 115, Fairfax, VA 22030-5026 | 2016-09-19 |
| Street Address |
11230 WAPLES MILL RD STE 115 |
| City | FAIRFAX |
| State | VA |
| Zip Code | 22030-5026 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114475118 | Revolution Meds Pharmacy Inc | Pharmacy | 11230 Waples Mill Rd Ste 115, Fairfax, VA 22030-5026 | 2016-09-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205449477 | Perry Camp Jr. | Psychologist | 4403 Dixie Hill Rd, Unit 205, Fairfax, VA 22030 | 2020-08-28 |
| 1952940322 | Brightview Fair Oaks, LLC | Alzheimer Center (Dementia Center) | 12725 Lee Highway, Fairfax, VA 22030 | 2020-01-02 |
| 1245871524 | Tori Sprowl | Behavioral Analyst | 10430 Democracy Lane #102b & 103, Fairfax, VA 22030 | 2019-10-08 |
| 1528612124 | Paul Sarigianis | Student in an Organized Health Care Education/Training Program | 10379b Democracy Lane, Fairfax, VA 22030 | 2019-07-31 |
| 1497221303 | Kahak, Inc. | Day Training, Developmentally Disabled Services | 10560 Main Street Suite Ps100, Fairfax, VA 22030 | 2018-10-17 |
| 1689177073 | Shamoona Sharif | Dentist | 11050 Lee Hwy, Fairfax, VA 22030 | 2018-03-13 |
| 1205339538 | Rachael Lee Greene | Social Worker | 4403 Dixie Hill Rd. #206, Fairfax, VA 22030 | 2018-03-13 |
| 1558863027 | Jacqueline Renee Bauer | Skilled Nursing Facility | 10701 Main Street, Fairfax, VA 22030 | 2018-03-01 |
| 1275033607 | Philajo Global LLC | Non-emergency Medical Transport (VAN) | 4521 Billingham Street, Fairfax, VA 22030 | 2018-02-12 |
| 1376050401 | Alexander Harrison | Counselor | 4400 University Drive, Ms 2a2, Fairfax, VA 22030 | 2018-01-10 |
| Find all providers in zip 22030 | ||||
| Taxonomy Code | 333600000X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: added definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922596691 | Prosperity Pharmacy Med Center Inc | Pharmacy | 8505 Arlington Blvd Ste 110, Fairfax, VA 22031-4636 | 2018-04-27 |
| 1114475118 | Revolution Meds Pharmacy Inc | Pharmacy | 11230 Waples Mill Rd Ste 115, Fairfax, VA 22030-5026 | 2016-09-19 |
| 1922407915 | Walgreens | Pharmacy | 3505 Nutley St, Suite A, Fairfax, VA 22031 | 2014-08-15 |
| 1750303616 | Hana Pharmacy, Inc. | Pharmacy | 11200 Fairfax Blvd., Fairfax, VA 22030 | 2006-07-23 |
| 1649203993 | Giant of Maryland LLC | Pharmacy | 11200 Main Street, Fairfax, VA 22030 | 2006-07-09 |
| 1780667980 | Wegmans Food Markets, Inc | Pharmacy | 11620 Monument Dr, Attn: Pharmacy Manager, Fairfax, VA 22030-8706 | 2005-11-22 |
| 1265057657 | Farzana Haque Kennedy | Pharmacy | 9868 Main St, Fairfax, VA 22031-3908 | 2020-06-11 |
| 1447783378 | Dewitt Army Community Hospital | Pharmacy | 10580 Arrowhead Dr, Fairfax, VA 22030-7301 | 2017-04-07 |
| 1033577184 | O&o Alpan, LLC | Pharmacy | 11212 Waples Mill Rd, Suite 100, Fairfax, VA 22030-7404 | 2016-02-03 |
| 1255738076 | Prosperity Rx Fairfax Inc | Pharmacy | 2740 Prosperity Ave Ste 200, Fairfax, VA 22031-4354 | 2014-11-21 |
| Find all providers in FAIRFAX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.