Healthcare Provider Details

I. General information

NPI: 1467413880
Provider Name (Legal Business Name): CENTRAL VIRGINIA HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 C POPLAR DRIVE
PETERSBURG VA
23803
US

IV. Provider business mailing address

321 C POPLAR DRIVE
PETERSBURG VA
23805
US

V. Phone/Fax

Practice location:
  • Phone: 804-733-5591
  • Fax: 804-957-5850
Mailing address:
  • Phone: 804-733-5591
  • Fax: 804-957-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0201001944
License Number StateVA

VIII. Authorized Official

Name: RODERICK MANIFOLD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 434-581-3273