Healthcare Provider Details

I. General information

NPI: 1396764379
Provider Name (Legal Business Name): NATIONALDIABETICPHARMACIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2157 APPERSON DR NATIONAL DIABETIC PHARMACIES
SALEM VA
24153-7235
US

IV. Provider business mailing address

2157 APPERSON DR NATIONAL DIABETIC PHARMACIES
SALEM VA
24153-7235
US

V. Phone/Fax

Practice location:
  • Phone: 540-777-0000
  • Fax:
Mailing address:
  • Phone: 540-777-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number StateVA

VIII. Authorized Official

Name: MRS. EVELYN SULLIVAN
Title or Position: ACCOUNT SERVICES
Credential:
Phone: 540-777-0000