Healthcare Provider Details

I. General information

NPI: 1720373681
Provider Name (Legal Business Name): FESTUS OPARA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 06/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3818 12TH ST NE
WASHINGTON DC
20017-2630
US

IV. Provider business mailing address

3818 12TH ST NE
WASHINGTON DC
20017-2630
US

V. Phone/Fax

Practice location:
  • Phone: 202-487-0509
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH3219
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: