Organization
MEDICAL FACULTY ASSOCIATES INC
Active
Other names
GW MEDICAL FACULTY ASSOCIATES PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN MOUTON PHARM. D. (EXECUTIVE DIRECTOR)
(202) 741-2218
Entity
Organization
Contact information
Practice address
2150 PENNSYLVANIA AVE NW, # G201, WASHINGTON, DC 20037-3201
(202) 741-3600
(202) 741-3606
Mailing address
2150 PENNSYLVANIA AVE NW, # G201, WASHINGTON, DC 20037-3201
(202) 741-3600
(202) 741-3606
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
RX0000301
DC
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0911970
—
DC
01
—
2004579
PK
—
Enumeration date
06/14/2006
Last updated
08/31/2023
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