Healthcare Provider Details

I. General information

NPI: 1992640817
Provider Name (Legal Business Name): CARLETTE DAWN CAVENAUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW RM GB-44A
WASHINGTON DC
20010-3017
US

IV. Provider business mailing address

4068 FOUNTAINSIDE LN
FAIRFAX VA
22030-6085
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-6645
  • Fax:
Mailing address:
  • Phone: 910-398-7513
  • Fax: 910-398-7513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH100003740
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: