Healthcare Provider Details

I. General information

NPI: 1457011876
Provider Name (Legal Business Name): TATIANA MARIE IRVINE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2021
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 ATLANTIC AVE
CHESAPEAKE VA
23324-3004
US

IV. Provider business mailing address

519 FRONT ST APT 401
NORFOLK VA
23510-1003
US

V. Phone/Fax

Practice location:
  • Phone: 757-543-9632
  • Fax:
Mailing address:
  • Phone: 808-690-3735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202220081
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: