Healthcare Provider Details

I. General information

NPI: 1043802960
Provider Name (Legal Business Name): KATRIVIA M FARMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR
NORFOLK VA
23507
US

IV. Provider business mailing address

5832 E HASTINGS ARCH
VIRGINIA BEACH VA
23462-1509
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-7833
  • Fax: 757-338-7835
Mailing address:
  • Phone: 757-478-8318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0230011878
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: