Provider Demographics
NPI:1437855517
Name:DEFENSE HEALTH AGENCY
Entity Type:Organization
Organization Name:DEFENSE HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SHARWANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-696-7924
Mailing Address - Street 1:401 CARPENTER RD # 525
Mailing Address - Street 2:
Mailing Address - City:FT MYER
Mailing Address - State:VA
Mailing Address - Zip Code:22211-1009
Mailing Address - Country:US
Mailing Address - Phone:703-696-7924
Mailing Address - Fax:
Practice Address - Street 1:401 CARPENTER RD # 525
Practice Address - Street 2:
Practice Address - City:FT MYER
Practice Address - State:VA
Practice Address - Zip Code:22211-1009
Practice Address - Country:US
Practice Address - Phone:703-696-7924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD082820180OtherPHARMACY TECHNICIAN