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NPI Code Detail

MEDICARE: GENOVA WASHINGTON

MEDICARE: GENOVA WASHINGTON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist0202213269VA
2183500000XPharmacistPH100003560DC
3183500000XPharmacist27062MD

General Provider Information

NPI Number : 1114557444
Entity Type Code : Individual
Provider Name (Legal Business Name) : GENOVA WASHINGTON
Provider Business Mailing Address
First Line : 1772 ADDISON RD S
Second Line :
City : DISTRICT HEIGHTS
State : MD
Zip : 20747-1569
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2970 SHASHO PL
Second Line :
City : WALDORF
State : MD
Zip : 20603-4840
Country : US
Telephone Number : 301-645-3095
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2020
Last Update Date : 01/26/2020

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Directions to “ GENOVA WASHINGTON ” Practice Location

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