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Individual
VIRGINIA POP
Active
Individual
VIRGINIA POP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPHT CERTIFIED PHARM
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
06516
AZ
183700000X
Pharmacy Technician
1101-0830-7336-813
NY
183700000X
Pharmacy Technician
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
539231
—
AZ
01
—
C60056371
MARICOPA MANAGED CARE SYS
—
Enumeration date
12/29/2006
Last updated
09/11/2025
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