Healthcare Provider Details

I. General information

NPI: 1942458575
Provider Name (Legal Business Name): NORTH CENTER PHARMACY DMH DC CSA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 SPRING RD NW ROOM 238
WASHINGTON DC
20010-1421
US

IV. Provider business mailing address

1125 SPRING RD NW ROOM 238
WASHINGTON DC
20010
US

V. Phone/Fax

Practice location:
  • Phone: 202-576-7265
  • Fax: 202-576-5707
Mailing address:
  • Phone: 202-576-7265
  • Fax: 202-576-5707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRX8800021
License Number StateDC

VIII. Authorized Official

Name: RUTH A. SMITH-LANDRY
Title or Position: SUPERVISOR
Credential: R.PH
Phone: 202-576-7265