Organization
GLOUCESTER MATHEWS CARE CLINIC
Active
Other names
GLOUCESTER MATHEWS CARE CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
KERRY DANACEAU (PIC)
(804) 642-9515
Entity
Organization
Contact information
Practice address
6031 INDUSTRIAL DR, GLOUCESTER, VA 23061-3767
(804) 642-9515
(804) 684-3691
Mailing address
6031 INDUSTRIAL DR, GLOUCESTER, VA 23061-3767
(804) 642-9515
(804) 684-3691
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
Primary
0201003539
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2104104
PK
—
Enumeration date
07/30/2006
Last updated
09/19/2025
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