Healthcare Provider Details

I. General information

NPI: 1225750136
Provider Name (Legal Business Name): VICTORIA ME'CHELLE DOWNS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 AVENUE D
PERRY POINT MD
21902-1000
US

IV. Provider business mailing address

7204 CLAGETT DR
HYATTSVILLE MD
20785-1972
US

V. Phone/Fax

Practice location:
  • Phone: 410-642-2411
  • Fax:
Mailing address:
  • Phone: 502-554-3168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number45474
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number45474
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number45474
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number45474
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number45474
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: