Provider Demographics
NPI:1114616778
Name:NOUBIT, BERTHE TATSIADA (PHARM D)
Entity Type:Individual
Prefix:
First Name:BERTHE
Middle Name:TATSIADA
Last Name:NOUBIT
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3389 BRISTOL CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-1339
Mailing Address - Country:US
Mailing Address - Phone:240-644-2703
Mailing Address - Fax:
Practice Address - Street 1:12601 SMOKETOWN RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-3379
Practice Address - Country:US
Practice Address - Phone:703-670-7030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist