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BULL RUN PROFESSIONAL PHARMACY
NPI 1881128544
Pharmacy - Community/Retail Pharmacy in Manassas, VA

Active since April 19, 2017CLIA 49D2198178 · Waiver
9210 CHURCH ST STE 100, MANASSAS, VA 20110(571) 357-4818(703) 782-9393 Get Directions Write a Review

NPPES record last updated: December 8, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Dec 8, 2021, Oct 25, 2019, Apr 19, 2017 (3 updates tracked since 2017).

About Bull Run Professional Pharmacy NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BULL RUN PROFESSIONAL PHARMACY (NPI 1881128544) is a healthcare organization registered as a community/retail pharmacy in Manassas, Virginia and active in the NPI registry since April 2017. The organization holds a CLIA Waiver certificate valid through October 29, 2026 and lists Vasumathi Vantikommu, Pharmacy Owner/manager, as its authorized official.

NPPES Registry Identity

NPI1881128544
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameAMITY HEALTH INC
Location Address9210 CHURCH ST STE 100Manassas, VA 20110-5524
Mailing Address42469 Nickens PlAshburn, VA 20148-8064 · (703) 568-2835
Phone(571) 357-4818
Fax(703) 782-9393
Organization SubpartNo
Authorized OfficialVasumathi VantikommuPharmacy Owner/manager · (703) 568-2835
Enumeration DateApril 19, 2017
Last NPPES UpdateDecember 8, 20213 updates tracked since enumeration
NPPES CertifiedDecember 8, 2021
✔ NPI 1881128544 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
License✔ Licensed in VA · 0201004763
Definition
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.
9210 CHURCH ST STE 100, Manassas, VA 20110
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Other Names 1

Doing Business AsBull Run Professional Pharmacy

Other Identifiers 2

Other2168741Pk
Medicaid2017136935VA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter from Arizona Complete Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 49D2198178

Bull Run Professional Pharmacy · Manassas, VA
Active · expires Oct 29, 2026
CLIA Number49D2198178
Laboratory TypePharmacy
Certificate Effective DateOctober 30, 2024
Certificate Expiration DateOctober 29, 2026
Laboratory DirectorVasumathi Vantikommu
Laboratory Phone(571) 357-4818
Laboratory LocationBull Run Professional Pharmacy9210 Church St Suite #100rd, Manassas, VA 20110
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Medical Equipment Supplier Medicare DMEPOS

Medicare supplier enrollment and the product categories Amity Health Inc carries, from the Medicare DMEPOS supplier directory.

Amity Health Inc

DMEPOS supplier · Manassas, VA
⋮

Does not accept Medicare assignment

Amity Health Inc has not agreed to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients may be charged more than the Medicare-approved amount; confirm the expected cost with the supplier before ordering.

PTAN (Medicare Supplier Number)20461619
Medicare Participant SinceMay 12, 2017
Supplier Location9210 Church St Ste 100Manassas, VA 20110
Phone(571) 357-4818
Supplier Specialties
Pharmacy

Medicare Product Categories

Nebulizer Drugs
Albuterol, levalbuterol, and metaproterenol are all short-acting bronchodilators with beta-adrenergic stimulatory effect
Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Amity Health Inc's NPI number?

The NPI number for Amity Health Inc is 1881128544. It was assigned to this organization in the NPPES registry on April 19, 2017. The provider is doing business as Bull Run Professional Pharmacy.

Where is Amity Health Inc located?

Amity Health Inc is located at 9210 Church St Ste 100, Manassas, VA 20110. The listed phone number is (571) 357-4818.

What is Amity Health Inc's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Does Amity Health Inc accept Medicare assignment for medical equipment?

No. As a Medicare medical equipment supplier, Amity Health Inc does not accept Medicare assignment for equipment and supplies, so patients may be charged more than the Medicare-approved amount. Confirm the expected cost with the supplier before ordering.

Does Amity Health Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 49D2198178) is associated with this NPI, valid through October 29, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Amity Health Inc accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter Health of Delaware, Ambetter from Absolute Total Care and Ambetter from Arizona Complete Health and 46 other insurers list Amity Health Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Amity Health Inc was last updated on December 8, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.