Basic Information
| Provider Information | |||||||||
| NPI: | 1134294705 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FORT BELVOIR COMMUNITY HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9300 DEWITT LOOP | ||||||||
| Address2: | ATTN TPCP | ||||||||
| City: | FORT BELVOIR | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220605901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5712312856 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9300 DEWITT LOOP | ||||||||
| Address2: | |||||||||
| City: | FORT BELVOIR | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5712313224 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2006 | ||||||||
| LastUpdateDate: | 08/13/2018 | ||||||||
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| AuthorizedOfficialLastName: | OH | ||||||||
| AuthorizedOfficialFirstName: | EMILY | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PHARMACIST | ||||||||
| AuthorizedOfficialTelephone: | 3014968092 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHARM.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | N | 193200000X MULTI-SPECIALTY GROUP | Pharmacy Service Providers | Pharmacist | 1835X0200X | 17930 | MD | N | 193200000X MULTI-SPECIALTY GROUP | Pharmacy Service Providers | Pharmacist | Oncology | 261QM1100X | N | Ambulatory Health Care Facilities | Clinic/Center | Military/U.S. Coast Guard Outpatient | 261QM1101X | N | Ambulatory Health Care Facilities | Clinic/Center | Military and U.S. Coast Guard Ambulatory Procedure | 2865M2000X | N | Hospitals | Military Hospital | Military General Acute Care Hospital | 341800000X | N | Transportation Services | Military/U.S. Coast Guard Transport | 332000000X | Y | Suppliers | Military/U.S. Coast Guard Pharmacy |
No ID Information.