Healthcare Provider Details

I. General information

NPI: 1275226086
Provider Name (Legal Business Name): MILAD N GERGES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1356 GASKINS RD
RICHMOND VA
23238-4919
US

IV. Provider business mailing address

4204 RIVERDALE AVE
GLEN ALLEN VA
23060-3385
US

V. Phone/Fax

Practice location:
  • Phone: 804-740-0011
  • Fax:
Mailing address:
  • Phone: 804-585-8277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0202221248
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: