Healthcare Provider Details

I. General information

NPI: 1346562014
Provider Name (Legal Business Name): MARC ZAVACKY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 HYDRAULIC RD
CHARLOTTESVILLE VA
22901-2839
US

IV. Provider business mailing address

2132 TARLETON DR
CHARLOTTESVILLE VA
22901-2957
US

V. Phone/Fax

Practice location:
  • Phone: 434-295-5184
  • Fax: 434-296-0573
Mailing address:
  • Phone: 434-975-2574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202008098
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: