Healthcare Provider Details

I. General information

NPI: 1538513965
Provider Name (Legal Business Name): UPSCALE HEALTH AND PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6233 GEORGIA AVE NW
WASHINGTON DC
20011-5111
US

IV. Provider business mailing address

6233 GEORGIA AVE NW
WASHINGTON DC
20011-5111
US

V. Phone/Fax

Practice location:
  • Phone: 202-652-0223
  • Fax: 202-652-0198
Mailing address:
  • Phone: 202-652-0223
  • Fax: 202-652-0198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberRX0000098
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NGOZI IKEJI
Title or Position: PHARMACIST
Credential:
Phone: 202-652-0223