Healthcare Provider Details

I. General information

NPI: 1922022862
Provider Name (Legal Business Name): RONNIE WAYNE HARVEY PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1579 LYNVILLE FORD RD
GOODVIEW VA
24095-2467
US

IV. Provider business mailing address

1579 LYNVILLE FORD RD
GOODVIEW VA
24095-2467
US

V. Phone/Fax

Practice location:
  • Phone: 540-890-3409
  • Fax: 540-297-6816
Mailing address:
  • Phone: 540-890-3409
  • Fax: 540-297-6816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202005151
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: