Healthcare Provider Details

I. General information

NPI: 1497334734
Provider Name (Legal Business Name): SUZANNA LYNN LUNSFORD PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 STEELES FORT RD STE B
RAPHINE VA
24472-2550
US

IV. Provider business mailing address

735 STEELES FORT RD STE B
RAPHINE VA
24472-2550
US

V. Phone/Fax

Practice location:
  • Phone: 540-851-1760
  • Fax: 540-851-1765
Mailing address:
  • Phone: 540-851-1760
  • Fax: 540-851-1765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number0202206996
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: