Healthcare Provider Details

I. General information

NPI: 1710223425
Provider Name (Legal Business Name): ALBERT SHOMADE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: AL SHOMADE PHARMD

II. Dates (important events)

Enumeration Date: 12/27/2012
Last Update Date: 12/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 14TH ST NW
WASHINGTON DC
20005-3610
US

IV. Provider business mailing address

7304 CARROLL AVE #105
TAKOMA PARK MD
20912-4514
US

V. Phone/Fax

Practice location:
  • Phone: 202-332-8811
  • Fax: 202-332-3880
Mailing address:
  • Phone: 301-477-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN64761
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR132831
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH100000654
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19065
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: