| Organization Name: | TARGET PHARMACY |
| NPI Number: | 1205291549 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ESSTEASE EMILE DOMINGUE (PHARMACIST) |
| Mailing Address: | 4310 Fortuna Center Plz Dumfries |
| State: | VA US |
| Postal Code: | 220251538 |
| Phone Number: | 7035866133 |
| Fax Number: | |
| NPI Enumeration Date: | 12/30/2015 |
| NPI Last Update Date: | 12/30/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QV0200X |
| License Number: | 0202212273 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | VA |
| Taxonomy Definition: | |