1891728440 NPI number — COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891728440 NPI number — COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VIRGINIA DEPARTMENT OF HEALTH PHARMACY SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891728440
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2448
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23218-2448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-786-1652
Provider Business Mailing Address Fax Number:
804-371-0236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 N 14TH ST
Provider Second Line Business Practice Location Address:
MONROE BLDG., ROOM S-45
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23219-3665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-786-1652
Provider Business Practice Location Address Fax Number:
804-371-0236
Provider Enumeration Date:
07/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WHEAWILL
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
804-786-4326

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  0201000080 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2125539 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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