Healthcare Provider Details

I. General information

NPI: 1386775112
Provider Name (Legal Business Name): CHRIS BUCHANAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S. BROAD ST.
KENBRIDGE VA
23944
US

IV. Provider business mailing address

PO BOX 538
KENBRIDGE VA
23944-0538
US

V. Phone/Fax

Practice location:
  • Phone: 434-676-2266
  • Fax: 434-676-1052
Mailing address:
  • Phone: 434-676-1393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202010672
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: