Healthcare Provider Details

I. General information

NPI: 1558635755
Provider Name (Legal Business Name): INFUSION PRN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4953 COX RD
GLEN ALLEN VA
23060-6296
US

IV. Provider business mailing address

4953 COX RD
GLEN ALLEN VA
23060-6296
US

V. Phone/Fax

Practice location:
  • Phone: 804-888-8630
  • Fax: 804-888-8628
Mailing address:
  • Phone: 804-888-8630
  • Fax: 804-888-8628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number0201004420
License Number StateVA

VIII. Authorized Official

Name: TAMARA EISELE
Title or Position: EVP/COO
Credential:
Phone: 804-747-8900