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NPI Code Detail

MEDICARE: MR. EDWARD MARION SHIBLEY JR. RPH, MBA

MEDICARE: MR. EDWARD MARION SHIBLEY JR. RPH, MBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist0202005006VA

General Provider Information

NPI Number : 1720126667
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EDWARD MARION SHIBLEY JR. RPH, MBA
Provider Business Mailing Address
First Line : 1717 BELLEVUE AVE
Second Line :
City : RICHMOND
State : VA
Zip : 23227-3961
Country : US
Telephone Number : 804-264-1319
Fax Number : 804-264-2133
Provider Business Practice Location Address
First Line : 1717 BELLEVUE AVE
Second Line :
City : RICHMOND
State : VA
Zip : 23227-3961
Country : US
Telephone Number : 804-264-1319
Fax Number : 804-264-2133
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2007
Last Update Date : 07/08/2007

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