Healthcare Provider Details

I. General information

NPI: 1487107983
Provider Name (Legal Business Name): MORTON 8TH ST PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2016
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 E CAPITOL ST NE
WASHINGTON DC
20003-1344
US

IV. Provider business mailing address

14371 BEAKER CT
BURTONSVILLE MD
20866-2050
US

V. Phone/Fax

Practice location:
  • Phone: 202-547-0403
  • Fax: 202-546-0467
Mailing address:
  • Phone: 202-547-0378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRX0000106
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANGELINE GAKUYA
Title or Position: PHARMACIST
Credential:
Phone: 202-547-0378