MEDICARE: KALORAMA PHARMACY INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1558994137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KALORAMA PHARMACY INC.

Provider Business Mailing Address
First Line	:	1841 COLUMBIA RD NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20009-2059
Country	:	US
Telephone Number	:	202-795-9711
Fax Number	:

Provider Business Practice Location Address
First Line	:	1841 COLUMBIA RD NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20009-2059
Country	:	US
Telephone Number	:	202-795-9711
Fax Number	:

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	WILLIAM FADEL
Credential	:
Telephone Number	:	703-943-7292

Provider Enumeration Date	:	02/21/2020
Last Update Date	:	02/21/2020

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