Provider Demographics
NPI:1366842577
Name:PHILIPOSE, BEENA
Entity Type:Individual
Prefix:MRS
First Name:BEENA
Middle Name:
Last Name:PHILIPOSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14156 SADDLE RIVER DR
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-4268
Mailing Address - Country:US
Mailing Address - Phone:202-550-6920
Mailing Address - Fax:
Practice Address - Street 1:9920 KEY WEST AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3455
Practice Address - Country:US
Practice Address - Phone:301-251-0024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA15120183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist