Healthcare Provider Details

I. General information

NPI: 1083947048
Provider Name (Legal Business Name): ORLANDO VAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 N WILLIAMSON BLVD
DAYTONA BEACH FL
32117-5250
US

IV. Provider business mailing address

PO BOX 94471
CLEVELAND OH
44101-4471
US

V. Phone/Fax

Practice location:
  • Phone: 386-323-7500
  • Fax: 407-513-9821
Mailing address:
  • Phone: 866-793-4591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332100000X
TaxonomyDepartment of Veterans Affairs (VA) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ERIN POTTER
Title or Position: NPI TEAM
Credential:
Phone: 202-382-2579