Healthcare Provider Details

I. General information

NPI: 1710017108
Provider Name (Legal Business Name): VIRGINIA CANCER INSITUTE WEST END
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6605 W BROAD ST SUITE A
RICHMOND VA
23230-1714
US

IV. Provider business mailing address

6605 W BROAD ST SUITE A
RICHMOND VA
23230-1714
US

V. Phone/Fax

Practice location:
  • Phone: 804-287-3000
  • Fax: 804-282-3314
Mailing address:
  • Phone: 804-287-3000
  • Fax: 804-282-3314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number0201003994
License Number StateVA

VIII. Authorized Official

Name: TABATHA FARMER III
Title or Position: CREDENTIALS
Credential:
Phone: 804-391-4171