Provider Demographics
NPI:1164019063
Name:POWELL, SHELDON MATTHEW (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHELDON
Middle Name:MATTHEW
Last Name:POWELL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 S PICKETT ST APT 201
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-4729
Mailing Address - Country:US
Mailing Address - Phone:917-804-1064
Mailing Address - Fax:
Practice Address - Street 1:259 S PICKETT ST APT 201
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-4729
Practice Address - Country:US
Practice Address - Phone:917-804-1064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-25
Last Update Date:2020-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202216109183500000X
DCPH100003929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202216109OtherPHARMACIST LICENSE
DCPH100003929OtherPHARMACIST LICENSE