=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831589381
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER WITTKORN PHARMD, BCPPS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2015
-----------------------------------------------------
Last Update Date | 01/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 MICHIGAN AVE NW
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20010-2916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-602-4751
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 912 MALTA LN
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20901-1135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-340-1304
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Pharmacist
-----------------------------------------------------
License Number | 8151870
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------