Healthcare Provider Details

I. General information

NPI: 1609464981
Provider Name (Legal Business Name): DIVANSH SINGH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 DEFENSE PENGATON
WASHINGTON DC
20310-0001
US

IV. Provider business mailing address

5801 DEFENSE PENTAGON
WASHINGTON DC
20310-0001
US

V. Phone/Fax

Practice location:
  • Phone: 703-692-6616
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202216197
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: