Healthcare Provider Details

I. General information

NPI: 1962583682
Provider Name (Legal Business Name): PROFESSIONAL PHARMACY SOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 COWARDIN AVE STE 104
RICHMOND VA
23224-2078
US

IV. Provider business mailing address

101 COWARDIN AVE STE 104
RICHMOND VA
23224-2078
US

V. Phone/Fax

Practice location:
  • Phone: 804-231-9422
  • Fax: 804-231-9442
Mailing address:
  • Phone: 804-231-9422
  • Fax: 804-231-9442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0230005060
License Number StateVA

VIII. Authorized Official

Name: MS. KIM NESHAE' HAMILTON
Title or Position: MANAGER/CPTH
Credential: CPTH
Phone: 804-231-9422