Healthcare Provider Details

I. General information

NPI: 1669179461
Provider Name (Legal Business Name): FRANK YACCARINO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 02/13/2023
Certification Date: 02/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9555 KINGS CHARTER DR STE D
ASHLAND VA
23005-7994
US

IV. Provider business mailing address

5508 BARNSLEY TER
GLEN ALLEN VA
23059-3424
US

V. Phone/Fax

Practice location:
  • Phone: 800-753-0596
  • Fax:
Mailing address:
  • Phone: 804-301-7880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202011906
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: