Provider Demographics
NPI:1942458575
Name:NORTH CENTER PHARMACY DMH DC CSA
Entity Type:Organization
Organization Name:NORTH CENTER PHARMACY DMH DC CSA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH-LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:202-576-7265
Mailing Address - Street 1:1125 SPRING RD NW
Mailing Address - Street 2:ROOM 238
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010
Mailing Address - Country:US
Mailing Address - Phone:202-576-7265
Mailing Address - Fax:202-576-5707
Practice Address - Street 1:1125 SPRING RD NW
Practice Address - Street 2:ROOM 238
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-1421
Practice Address - Country:US
Practice Address - Phone:202-576-7265
Practice Address - Fax:202-576-5707
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEPT OF MENTAL HEALTH DC CSA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRX88000213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCAN7003596OtherDRUG ENFORCEMENT ADMINISTRATION (DEA)