Individual
NGHI NGTAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
20 BUFORD RD, NORTH CHESTERFIELD, VA 23235-5202
(804) 320-9752
Mailing address
403 SHADOW CREEK LN, MANAKIN SABOT, VA 23103-2537
(858) 537-7234
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0202216227
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0202216227
PHARMACIST
VA
Enumeration date
10/05/2018
Last updated
10/05/2018
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