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NPI Code Detail

MEDICARE: BETEWOIN DUBALE

MEDICARE:   BETEWOIN  DUBALE
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
1183500000XPharmacist0202210717VA

General Provider Information

NPI Number : 1619380441
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETEWOIN DUBALE
Provider Business Mailing Address
First Line : 3712 ROXBURY LN
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22309-3731
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2820 COLUMBIA PIKE
Second Line :
City : ARLINGTON
State : VA
Zip : 22204-4412
Country : US
Telephone Number : 703-521-3143
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2014
Last Update Date : 06/10/2014

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Directions to “ BETEWOIN DUBALE ” Practice Location

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