Healthcare Provider Details

I. General information

NPI: 1164801809
Provider Name (Legal Business Name): KAELA KELUSKAR PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 IRVING ST NW
WASHINGTON DC
20422-2226
US

IV. Provider business mailing address

50 IRVING ST NW
WASHINGTON DC
20422-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-8000
  • Fax:
Mailing address:
  • Phone: 202-745-8000
  • Fax: 202-745-8639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number62409
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: