| NPI | 1942358957 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLA POWELL Dms 804-264-7808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: VA 213000654) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2020-08-22 |