Active NPI
Mary Boseman Powell, PHARMD
- Pharmacist
- Joint Base Langley-Eustis, VA
National Provider Identifier
1639436660
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 0202207258
- Practice address
- 77 Nealy Avenue
633D Medical Group
Joint Base Langley-Eustis, VA 23665-2040 - Phone
- (757) 225-7630
- NPI assigned
- Apr 16, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0202207258 | VA | Primary |
| Pharmacist | 183500000X | 17996 | NC |
Addresses
Primary practice location
77 Nealy Avenue
633D Medical Group
Joint Base Langley-Eustis, VA 23665-2040
Mailing address
77 Nealy Avenue
633D Medical Group
Joint Base Langley-Eustis, VA 23665-2040
Phone (757) 225-7630
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0202207258 | VA | MD | Pharmacist |
| 17996 | NC | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1334534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1334534400000",
"number": "1639436660",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "77 NEALY AVENUE",
"address_2": "633D MEDICAL GROUP",
"city": "JOINT BASE LANGLEY-EUSTIS",
"state": "VA",
"postal_code": "236652040",
"telephone_number": "757-225-7630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "77 NEALY AVENUE",
"address_2": "633D MEDICAL GROUP",
"city": "JOINT BASE LANGLEY-EUSTIS",
"state": "VA",
"postal_code": "236652040",
"telephone_number": "757-225-7630"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POWELL",
"first_name": "MARY",
"middle_name": "BOSEMAN",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-04-16",
"last_updated": "2012-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "VA",
"license": "0202207258",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NC",
"license": "17996",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Joint Base Langley-Eustis, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.