Provider Demographics
NPI:1790828069
Name:CONWAY, KRISTINE E (RPH, JD)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:E
Last Name:CONWAY
Suffix:
Gender:F
Credentials:RPH, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10623 OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-3913
Mailing Address - Country:US
Mailing Address - Phone:703-424-6312
Mailing Address - Fax:
Practice Address - Street 1:10623 OLIVER ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3913
Practice Address - Country:US
Practice Address - Phone:703-424-6312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202008079183500000X, 1835P1200X
MD18635183500000X, 1835P1200X
DCPH100000516183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist