Healthcare Provider Details

I. General information

NPI: 1699379958
Provider Name (Legal Business Name): SYDNEY HURLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2020
Last Update Date: 11/27/2020
Certification Date: 11/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9498 CHARTER GATE DR
MECHANICSVILLE VA
23116-5171
US

IV. Provider business mailing address

9498 CHARTER GATE DR
MECHANICSVILLE VA
23116-5171
US

V. Phone/Fax

Practice location:
  • Phone: 804-550-4912
  • Fax: 804-550-9181
Mailing address:
  • Phone: 804-550-4912
  • Fax: 804-550-9181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202213116
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: