Healthcare Provider Details

I. General information

NPI: 1285205757
Provider Name (Legal Business Name): GRACE LIMBAUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7864 RICHMOND TAPPAHANNOCK HWY
AYLETT VA
23009-3056
US

IV. Provider business mailing address

10103 CONTESSA DR
GLEN ALLEN VA
23060-3706
US

V. Phone/Fax

Practice location:
  • Phone: 504-769-2015
  • Fax: 804-769-2014
Mailing address:
  • Phone: 804-755-7153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202007507
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: