Healthcare Provider Details

I. General information

NPI: 1376452375
Provider Name (Legal Business Name): CAPRI WILLARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20995 POINT LOOKOUT RD
CALLAWAY MD
20620-2340
US

IV. Provider business mailing address

20995 POINT LOOKOUT RD
CALLAWAY MD
20620-2340
US

V. Phone/Fax

Practice location:
  • Phone: 301-994-1099
  • Fax:
Mailing address:
  • Phone: 301-994-1099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberT30880
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: