Healthcare Provider Details

I. General information

NPI: 1831589381
Provider Name (Legal Business Name): HEATHER WITTKORN PHARMD, BCPPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

912 MALTA LN
SILVER SPRING MD
20901-1135
US

V. Phone/Fax

Practice location:
  • Phone: 202-602-4751
  • Fax:
Mailing address:
  • Phone: 856-340-1304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License Number8151870
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: