Healthcare Provider Details

I. General information

NPI: 1134065733
Provider Name (Legal Business Name): ALLISON NICOLE ANTONIUS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON NICOLE MONSELL PHARMD

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 BELLEVIEW AVE SE
ROANOKE VA
24014-1838
US

IV. Provider business mailing address

1906 BELLEVIEW AVE SE
ROANOKE VA
24014-1838
US

V. Phone/Fax

Practice location:
  • Phone: 540-855-1551
  • Fax:
Mailing address:
  • Phone: 540-855-1551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number0202220021
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: