Healthcare Provider Details

I. General information

NPI: 1194496000
Provider Name (Legal Business Name): KWESI A SEFA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 09/22/2021
Certification Date: 09/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521-1523 NORTH QUAKER LANE
ALEXANDRIA VA
22302
US

IV. Provider business mailing address

8804 TEMPLE HILL RD
CLINTON MD
20735-2454
US

V. Phone/Fax

Practice location:
  • Phone: 703-998-6560
  • Fax:
Mailing address:
  • Phone: 240-413-5323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202219922
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: