Healthcare Provider Details

I. General information

NPI: 1467052845
Provider Name (Legal Business Name): TINA FIRESTONE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3259 CATLIN AVE
QUANTICO VA
22134-5109
US

IV. Provider business mailing address

39991 BRADDOCK RD
ALDIE VA
20105-2782
US

V. Phone/Fax

Practice location:
  • Phone: 703-784-1580
  • Fax:
Mailing address:
  • Phone: 703-307-8316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202204866
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: