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General NPI Number Information
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NPI Number | 1467596577
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Entity Type | Organization
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Legal Business Name | PETWORTH CARE PHARMACY
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4809 GEORGIA AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20011-4533
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Country | US
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Telephone | 202-722-4330
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Fax | 202-722-7143
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Provider Business Mailing Address
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Address Line | 4809 GEORGIA AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20011-4533
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Country | US
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Telephone | 202-722-4330
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Fax | 202-722-7143
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Authorized Official
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Title or Position | PHARMACIST INCHARGE
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Name | MESFIN GEGZIABHEAR
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Credential | RPH
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Telephone | 202-722-4330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | RX0500337
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License Number State | DC
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