Healthcare Provider Details

I. General information

NPI: 1497440457
Provider Name (Legal Business Name): HOLYANNA OBCEMANE CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 VOLVO PKWY
CHESAPEAKE VA
23320-7654
US

IV. Provider business mailing address

1201 VOLVO PKWY
CHESAPEAKE VA
23320-7654
US

V. Phone/Fax

Practice location:
  • Phone: 757-436-9157
  • Fax:
Mailing address:
  • Phone: 757-436-9157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0230022149
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: