Healthcare Provider Details

I. General information

NPI: 1700412038
Provider Name (Legal Business Name): VICTOR GITUMA NJOGU PHARMACY TECHNICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 28TH ST S APT 4
ARLINGTON VA
22206-3235
US

IV. Provider business mailing address

1527 28TH ST S APT 4
ARLINGTON VA
22206-3235
US

V. Phone/Fax

Practice location:
  • Phone: 703-559-4903
  • Fax:
Mailing address:
  • Phone: 703-559-4903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPT01129
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: