Healthcare Provider Details

I. General information

NPI: 1437013943
Provider Name (Legal Business Name): IMANI MCPHATTER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11101 GLISSADE DR
CLINTON MD
20735-1079
US

IV. Provider business mailing address

11101 GLISSADE DR
CLINTON MD
20735-1079
US

V. Phone/Fax

Practice location:
  • Phone: 202-704-1174
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number34346
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: