Provider Demographics
NPI:1619423811
Name:WINSTON, DELISA (RPH)
Entity Type:Individual
Prefix:
First Name:DELISA
Middle Name:
Last Name:WINSTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 EAST CAPITOL STREET NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-3809
Mailing Address - Country:US
Mailing Address - Phone:202-543-4400
Mailing Address - Fax:202-204-0670
Practice Address - Street 1:326 E CAPITOL ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-3809
Practice Address - Country:US
Practice Address - Phone:202-543-4400
Practice Address - Fax:202-204-0670
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPHA3045183500000X
MD15938183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist