Healthcare Provider Details

I. General information

NPI: 1104262393
Provider Name (Legal Business Name): JANET E OWEN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2213 CEDAR MILL CT
VIENNA VA
22182-5245
US

IV. Provider business mailing address

2213 CEDAR MILL CT
VIENNA VA
22182-5245
US

V. Phone/Fax

Practice location:
  • Phone: 703-204-0629
  • Fax: 703-287-4651
Mailing address:
  • Phone: 703-204-0629
  • Fax: 703-287-4651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202207757
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: