Organization
OTR FIRMS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEANAN HENDERSON (MANAGER)
(252) 389-9082
Entity
Organization
Contact information
Practice address
600 CHURCH ST RM 141, NORFOLK, VA 23501-9908
(252) 389-9082
Mailing address
PO BOX 141, NORFOLK, VA 23501-0141
Taxonomy
Speciality
Code
Description
License number
State
3336M0002X
Mail Order Pharmacy
Primary
—
—
Other
Enumeration date
09/20/2019
Last updated
09/20/2019
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