Healthcare Provider Details

I. General information

NPI: 1083724678
Provider Name (Legal Business Name): ROBERT B KALTSOUNIS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 WILLOW LAWN DR
RICHMOND VA
23230
US

IV. Provider business mailing address

3629 MILBURY RUN ST
RICHMOND VA
23233-7670
US

V. Phone/Fax

Practice location:
  • Phone: 804-282-5421
  • Fax:
Mailing address:
  • Phone: 804-364-4730
  • Fax: 804-364-2622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202205108
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: