Healthcare Provider Details

I. General information

NPI: 1407378581
Provider Name (Legal Business Name): KAYSEE DWYER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAYSEE GRUSS PHARMD

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 OLD DOMINION DR STE C
MC LEAN VA
22102-2034
US

IV. Provider business mailing address

8100 OLD DOMINION DR STE C
MC LEAN VA
22102-2034
US

V. Phone/Fax

Practice location:
  • Phone: 703-827-0990
  • Fax: 800-662-4945
Mailing address:
  • Phone: 703-827-0990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP453159
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202216261
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25022
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: