Healthcare Provider Details

I. General information

NPI: 1124615992
Provider Name (Legal Business Name): AARON LESLIE ANDERSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2020
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 FASHION RD STE AB
POUNDING MILL VA
24637-1200
US

IV. Provider business mailing address

111 FASHION RD STE AB
POUNDING MILL VA
24637-1200
US

V. Phone/Fax

Practice location:
  • Phone: 276-964-0555
  • Fax: 276-964-2999
Mailing address:
  • Phone: 276-964-0555
  • Fax: 276-964-2999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202217945
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: