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General NPI Number Information
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NPI Number | 1700375318
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Entity Type | Organization
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Legal Business Name | GREEN HEALTH INTEGRATIVE & WELLNESS PHARMACY
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Dates
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Enumeration Date | 05/09/2018
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Last Update Date | 05/09/2018
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Provider Practice Location Address
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Address Line | 2898 DALE BLVD UNIT 105
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City | WOODBRIDGE
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State | VA
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Zip | 22193-1118
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Country | US
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Telephone | 703-499-2373
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Fax |
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Provider Business Mailing Address
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Address Line | 6047 TICKET WAY
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City | WOODBRIDGE
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State | VA
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Zip | 22193-6138
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Country | US
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Telephone | 703-499-2373
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Fax |
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Authorized Official
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Title or Position | CEO/MANAGING PRACTITIONER
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Name | DR. KWAME BINFO ENNIN
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Credential | PHARMD
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Telephone | 703-499-2373
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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 |
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License Number State |
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