Provider Demographics
NPI:1902167406
Name:WHITFIELD, KIESHA L (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KIESHA
Middle Name:L
Last Name:WHITFIELD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11215 OAK LEAF DR
Mailing Address - Street 2:APT 1909
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1317
Mailing Address - Country:US
Mailing Address - Phone:757-593-3659
Mailing Address - Fax:
Practice Address - Street 1:3250 SUPERIOR LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1916
Practice Address - Country:US
Practice Address - Phone:301-805-1866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17013183500000X
VA0202208953183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist