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General NPI Number Information
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NPI Number | 1750324083
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Entity Type | Organization
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Legal Business Name | MEDICAL FACULTY ASSOCIATES INC
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 08/31/2023
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Provider Practice Location Address
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Address Line | 2150 PENNSYLVANIA AVE NW # G201
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City | WASHINGTON
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State | DC
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Zip | 20037-3201
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Country | US
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Telephone | 202-741-3600
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Fax | 202-741-3606
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Provider Business Mailing Address
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Address Line | 2150 PENNSYLVANIA AVE NW # G201
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City | WASHINGTON
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State | DC
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Zip | 20037-3201
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Country | US
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Telephone | 202-741-3600
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Fax | 202-741-3606
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. RYAN MOUTON
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Credential | PHARM. D.
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Telephone | 202-741-2218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | RX0000301
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License Number State | DC
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