Healthcare Provider Details

I. General information

NPI: 1629160767
Provider Name (Legal Business Name): CHESTERFIELD COUNTY DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 LUCY CORR CR
CHESTERFIELD VA
23832-0002
US

IV. Provider business mailing address

9501 LUCY CORR CR P.O. BOX 100
CHESTERFIELD VA
23832-0002
US

V. Phone/Fax

Practice location:
  • Phone: 804-748-1746
  • Fax: 804-751-4497
Mailing address:
  • Phone: 804-748-1746
  • Fax: 804-751-4497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number0201001738
License Number StateVA

VIII. Authorized Official

Name: MRS. BRENDA EARLEY
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 804-748-1746