Healthcare Provider Details

I. General information

NPI: 1467072215
Provider Name (Legal Business Name): ANNA STACIA ELECTRA JOSEPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3860 INTERNATIONAL DR
SILVER SPRING MD
20906-1548
US

IV. Provider business mailing address

650 FAIRMONT DR APT 412
BOWIE MD
20716-3757
US

V. Phone/Fax

Practice location:
  • Phone: 301-598-3208
  • Fax:
Mailing address:
  • Phone: 301-364-2046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number31030
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: