| NPI | 1790055945 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFF VANSCHAACK Pharmacist 757-472-8580 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: VA 0202204450) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: NC 14803) |
| Enumeration Date | 2012-01-05 |
| Last Update Date | 2012-01-05 |