MEDICARE: DR. STELLA N KINTU PHARM.D

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	183500000X	Pharmacist	0202012960	VA
2	1835G0303X	Geriatric Pharmacist	0202012960	VA
3	1835P1200X	Pharmacotherapy Pharmacist	0202012960	VA
4	1835P1200X	Pharmacotherapy Pharmacist	PH100001894	DC
5	1835P1300X	Psychiatric Pharmacist	PH100001894	DC
6	1835X0200X	Oncology Pharmacist	PH100001894	DC
7	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	0202012960	VA

General Provider Information

NPI Number	:	1710353248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STELLA N KINTU PHARM.D

Provider Business Mailing Address
First Line	:	4215 DALE BLVD
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-2243
Country	:	US
Telephone Number	:	703-878-1837
Fax Number	:	866-412-3880

Provider Business Practice Location Address
First Line	:	4215 DALE BLVD
Second Line	:	TDS HEALTH
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-2243
Country	:	US
Telephone Number	:	703-897-1837
Fax Number	:	703-897-4862

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2015
Last Update Date	:	12/31/2018

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