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Individual

DR. ELLEN DAWN DEMUCCI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PHARMD

Contact information

Practice address
100 BRANDICE ST, STAFFORD, VA 22554-7197
(540) 429-6299
Mailing address
100 BRANDICE ST, STAFFORD, VA 22554-7197
(540) 429-6299

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0202009712
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0202009712
PHARMACY PRACTICE LICENSE
VA
Enumeration date
06/20/2008
Last updated
06/20/2008
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