Healthcare Provider Details

I. General information

NPI: 1710200068
Provider Name (Legal Business Name): H STREET PHARMACY AND WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2010
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 H ST NE
WASHINGTON DC
20002-3629
US

IV. Provider business mailing address

812 H ST NE
WASHINGTON DC
20002-3629
US

V. Phone/Fax

Practice location:
  • Phone: 202-621-9665
  • Fax: 202-621-9703
Mailing address:
  • Phone: 202-621-9665
  • Fax: 202-621-9703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRX1000420
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KAPIAMBA MUTEBA
Title or Position: PHARMACIST/OWNER
Credential:
Phone: 301-404-6067