Individual provider Active NPI

Genova Washington

  • Pharmacist
  • Waldorf, MD
National Provider Identifier
1114557444
Registry record updated Jan 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
27062 Issued in MD
Practice address
2970 Shasho PL
Waldorf, MD 20603-4840
Phone
(301) 645-3095
NPI assigned
Jan 26, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 0202213269 VA
Pharmacist 183500000X PH100003560 DC
Pharmacist 183500000X 27062 MD Primary

Addresses

Primary practice location

2970 Shasho PL
Waldorf, MD 20603-4840

Mailing address

1772 Addison Rd S
District Heights, MD 20747-1569

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PH100003560DCMDPharmacist
27062MDMDPharmacist
0202213269VAMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1579996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579996800000",
    "number": "1114557444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1772 ADDISON RD S",
            "city": "DISTRICT HEIGHTS",
            "state": "MD",
            "postal_code": "207471569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2970 SHASHO PL",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034840",
            "telephone_number": "301-645-3095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASHINGTON",
        "first_name": "GENOVA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-26",
        "last_updated": "2020-01-26",
        "certification_date": "2020-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "VA",
            "license": "0202213269",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "DC",
            "license": "PH100003560",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MD",
            "license": "27062",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waldorf, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.