Healthcare Provider Details

I. General information

NPI: 1508463381
Provider Name (Legal Business Name): DOROTHY RASNICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 MARKET ST
NORTH TAZEWELL VA
24630-5015
US

IV. Provider business mailing address

121 STRATFORD LN
NORTH TAZEWELL VA
24630-8577
US

V. Phone/Fax

Practice location:
  • Phone: 276-988-6593
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0011389
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202213967
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: