Healthcare Provider Details

I. General information

NPI: 1659976249
Provider Name (Legal Business Name): REBECCA HURST PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 S MAIN ST
BLACKSBURG VA
24060-5825
US

IV. Provider business mailing address

1775 S MAIN ST
BLACKSBURG VA
24060-5825
US

V. Phone/Fax

Practice location:
  • Phone: 540-951-8595
  • Fax: 540-961-1796
Mailing address:
  • Phone: 540-951-8595
  • Fax: 540-961-1796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202211159
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: