Healthcare Provider Details

I. General information

NPI: 1275119034
Provider Name (Legal Business Name): ALEXANDRIA VICTORIA STANLEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23906 DICKENSON HWY
HAYSI VA
24256-5992
US

IV. Provider business mailing address

PO BOX 515
HAYSI VA
24256-0515
US

V. Phone/Fax

Practice location:
  • Phone: 276-865-5135
  • Fax: 276-865-5006
Mailing address:
  • Phone: 276-865-5135
  • Fax: 276-865-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202219165
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: