Healthcare Provider Details

I. General information

NPI: 1033693767
Provider Name (Legal Business Name): JEWELL J REDDICK PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 2ND ST NE
WASHINGTON DC
20002-8100
US

IV. Provider business mailing address

400 GALLOWAY ST NE APT 215N
WASHINGTON DC
20011-6449
US

V. Phone/Fax

Practice location:
  • Phone: 202-346-3000
  • Fax:
Mailing address:
  • Phone: 850-459-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH100000514
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS42987
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: