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General NPI Number Information
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NPI Number | 1740006360
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Entity Type | Individual
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Provider Name | JOSEPHINE KOOMSON
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Gender | Female
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Dates
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Enumeration Date | 11/27/2024
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 14361 NEWBROOK DR
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City | CHANTILLY
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State | VA
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Zip | 20151-4228
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Country | US
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Telephone | 571-525-5565
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Fax |
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Provider Business Mailing Address
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Address Line | 8911 VIRGINIA AVE
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City | MANASSAS
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State | VA
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Zip | 20110-6119
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Country | US
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Telephone | 571-354-9135
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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 | 0202222484
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License Number State | VA
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