Healthcare Provider Details

I. General information

NPI: 1417558123
Provider Name (Legal Business Name): TAI VU PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10901 W BROAD ST
GLEN ALLEN VA
23060-5935
US

IV. Provider business mailing address

10901 W BROAD ST
GLEN ALLEN VA
23060-5935
US

V. Phone/Fax

Practice location:
  • Phone: 804-935-6916
  • Fax:
Mailing address:
  • Phone: 804-935-6916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202223244
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: