Healthcare Provider Details

I. General information

NPI: 1932534179
Provider Name (Legal Business Name): ELWOOD PITTS JR. CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 09/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 COX RD STE 100
GLEN ALLEN VA
23060-9263
US

IV. Provider business mailing address

5000 COX RD STE 100
GLEN ALLEN VA
23060-9263
US

V. Phone/Fax

Practice location:
  • Phone: 804-822-4588
  • Fax: 804-965-0987
Mailing address:
  • Phone: 804-822-4588
  • Fax: 804-965-0987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0230008417
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: