Healthcare Provider Details

I. General information

NPI: 1790883312
Provider Name (Legal Business Name): IVAN PURNELL CEPHAS PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 IRVING ST NW PHARMACY SERVICE (119)
WASHINGTON DC
20422-0001
US

IV. Provider business mailing address

3106 35TH ST NE
WASHINGTON DC
20018-1628
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-8000
  • Fax: 202-745-8639
Mailing address:
  • Phone: 202-635-0567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS 36007
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: