Healthcare Provider Details

I. General information

NPI: 1770209249
Provider Name (Legal Business Name): GEORGE A LYGHT PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3169 MOUNT PLEASANT ST NW
WASHINGTON DC
20010-2709
US

IV. Provider business mailing address

3004 CITATION CT
BOWIE MD
20721-1291
US

V. Phone/Fax

Practice location:
  • Phone: 202-387-3100
  • Fax:
Mailing address:
  • Phone: 240-463-0467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPHA2414
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: