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General NPI Number Information
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NPI Number | 1124303201
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Entity Type | Individual
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Provider Name | GREGORINA ALTAGRACIA CAMPUSANO
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Gender | Female
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Dates
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Enumeration Date | 10/20/2011
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Last Update Date | 10/20/2011
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Provider Practice Location Address
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Address Line | 3524 CONNECTICUT AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20008-2401
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Country | US
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Telephone | 202-686-6927
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Fax | 202-686-3870
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Provider Business Mailing Address
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Address Line | 2931 11TH ST NW
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City | WASHINGTON
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State | DC
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Zip | 20001-3903
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Country | US
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Telephone | 202-714-4488
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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 | PH100000807
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 17085
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License Number State | MD
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