Individual
MAYA PATTERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6150 COLLEGE DRIVE, SUFFOLK, VA 23435
(757) 638-2912
Mailing address
6150 COLLEGE DR, SUFFOLK, VA 23435-3684
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0202216131
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0202216131
PHARMACY LICENSE
VA
Enumeration date
08/19/2017
Last updated
08/19/2017
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