Provider Demographics
NPI:1114949039
Name:CHARTERED MEDICAL PHARMACY
Entity Type:Organization
Organization Name:CHARTERED MEDICAL PHARMACY
Other - Org Name:CHARTERED FAMILY HEALTH CENTER PC
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DUCIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUMBS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST RPH
Authorized Official - Phone:202-627-7855
Mailing Address - Street 1:3924 MINNESOTA AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019
Mailing Address - Country:US
Mailing Address - Phone:202-627-7809
Mailing Address - Fax:202-627-7836
Practice Address - Street 1:3924 MINNESOTA AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019
Practice Address - Country:US
Practice Address - Phone:202-627-7809
Practice Address - Fax:202-627-7836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRX9700280333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy