Organization
UPPER MATTAPONI INDIAN TRIBE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY MCQUEEN (DIRECTOR OF CREDENTIALING AND COMPL)
(804) 535-0145
Entity
Organization
Contact information
Practice address
7453 HARGETT BLVD, GLOUCESTER, VA 23061-2038
(804) 694-3999
(800) 853-2692
Mailing address
7453 HARGETT BLVD, GLOUCESTER, VA 23061-2038
(804) 694-3999
(804) 769-2014
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
05/11/2026
Last updated
05/11/2026
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