Healthcare Provider Details

I. General information

NPI: 1144676909
Provider Name (Legal Business Name): PROPRIUM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 INDEPENDENCE PKWY SUITE 400
CHESAPEAKE VA
23320-5176
US

IV. Provider business mailing address

535 INDEPENDENCE PKWY SUITE 400
CHESAPEAKE VA
23320-5176
US

V. Phone/Fax

Practice location:
  • Phone: 757-553-3568
  • Fax: 757-819-7827
Mailing address:
  • Phone: 757-553-3568
  • Fax: 757-819-7827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LINDA R HUFFER
Title or Position: PRESIDENT
Credential:
Phone: 757-553-3111