Provider Demographics
NPI:1881121168
Name:DUPONT CIRCLE INC
Entity type:Organization
Organization Name:DUPONT CIRCLE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:ADDICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-818-8070
Mailing Address - Street 1:1506 21ST ST NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-1006
Mailing Address - Country:US
Mailing Address - Phone:202-818-8070
Mailing Address - Fax:202-818-8071
Practice Address - Street 1:1506 21ST ST NW STE 100
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-1017
Practice Address - Country:US
Practice Address - Phone:202-818-8070
Practice Address - Fax:202-818-8071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-17
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336S0011X
DCRX17001173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1881121168Medicaid
DC091062599Medicaid
DC032158189Medicaid
2170031OtherPK
7711210001OtherNSC
ILHCO651340OtherSPECIALTY PHARMACY
MD123189800Medicaid