1861707077 NPI number — MRS. NICOLE JULIA VARNADO PHARMD

Table of content: MRS. NICOLE JULIA VARNADO PHARMD (NPI 1861707077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861707077 NPI number — MRS. NICOLE JULIA VARNADO PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VARNADO
Provider First Name:
NICOLE
Provider Middle Name:
JULIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCNEIL
Provider Other First Name:
NICOLE
Provider Other Middle Name:
JULIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861707077
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
480 KEMPSVILLE RD
Provider Second Line Business Mailing Address:
STE 108
Provider Business Mailing Address City Name:
CHESAPEAKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23320-3868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-216-9678
Provider Business Mailing Address Fax Number:
757-512-5346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
480 KEMPSVILLE RD
Provider Second Line Business Practice Location Address:
STE 108
Provider Business Practice Location Address City Name:
CHESAPEAKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23320-3868
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-216-9678
Provider Business Practice Location Address Fax Number:
757-512-5346
Provider Enumeration Date:
08/11/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  018902 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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