Healthcare Provider Details

I. General information

NPI: 1235813106
Provider Name (Legal Business Name): KIARA EDMONDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 WESTOVER HILLS BLVD
RICHMOND VA
23225-4434
US

IV. Provider business mailing address

542 BRIARWOOD CIR
NORTH PRINCE GEORGE VA
23860-7302
US

V. Phone/Fax

Practice location:
  • Phone: 804-230-6335
  • Fax:
Mailing address:
  • Phone: 804-630-1119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0230027973
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: