Healthcare Provider Details

I. General information

NPI: 1811668403
Provider Name (Legal Business Name): TATYANA ANISSA CAWTHORNE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 09/23/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 14TH ST SE
WASHINGTON DC
20003-3002
US

IV. Provider business mailing address

415 14TH ST SE
WASHINGTON DC
20003-3002
US

V. Phone/Fax

Practice location:
  • Phone: 202-920-5875
  • Fax:
Mailing address:
  • Phone: 202-920-5875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH20004099
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: