Individual
MICHAELENE CUSTODIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMACIST
Contact information
Practice address
3514 W CARY ST, RICHMOND, VA 23221-2729
(804) 355-8533
Mailing address
3514 W CARY ST, RICHMOND, VA 23221-2729
(804) 355-8533
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0202220240
VA
183500000X
Pharmacist
80868
CA
Other
Enumeration date
12/16/2019
Last updated
05/14/2023
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