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General NPI Number Information
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NPI Number | 1114616778
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Entity Type | Individual
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Provider Name | BERTHE TATSIADA NOUBIT PHARM D
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Gender | Female
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Dates
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Enumeration Date | 05/01/2023
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Last Update Date | 05/01/2023
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Provider Practice Location Address
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Address Line | 12601 SMOKETOWN RD
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City | WOODBRIDGE
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State | VA
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Zip | 22192-3379
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Country | US
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Telephone | 703-670-7030
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Fax |
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Provider Business Mailing Address
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Address Line | 3389 BRISTOL CT
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City | WOODBRIDGE
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State | VA
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Zip | 22193-1339
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Country | US
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Telephone | 240-644-2703
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 43809
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License Number State | SC
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