=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093097164
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ABIGAIL SARPONG PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2011
-----------------------------------------------------
Last Update Date | 07/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8414 OLD KEENE MILL RD UNIT A
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22152-2302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-913-6712
-----------------------------------------------------
Fax | 703-913-6718
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3176 TULIP TREE PL
-----------------------------------------------------
City | DUMFRIES
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22026-4554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-893-5626
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 0202209992
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------