Healthcare Provider Details

I. General information

NPI: 1316923527
Provider Name (Legal Business Name): JOHN ANDREW NEIDERER R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 COLONY RD
MADISON HEIGHTS VA
24572-2105
US

IV. Provider business mailing address

3556 GREGORY LN
LYNCHBURG VA
24503-3208
US

V. Phone/Fax

Practice location:
  • Phone: 434-947-2081
  • Fax: 434-947-2368
Mailing address:
  • Phone: 434-947-2081
  • Fax: 434-947-2368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202010093
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: