Healthcare Provider Details

I. General information

NPI: 1497353692
Provider Name (Legal Business Name): DAVID JUNE ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 10/17/2020
Certification Date: 10/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 HALIFAX RD STE B
SOUTH BOSTON VA
24592-4833
US

IV. Provider business mailing address

4121 HALIFAX RD STE B
SOUTH BOSTON VA
24592-4833
US

V. Phone/Fax

Practice location:
  • Phone: 434-575-0511
  • Fax: 434-575-1366
Mailing address:
  • Phone: 434-575-0511
  • Fax: 434-575-1366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN ANDERSON
Title or Position: OWNER
Credential: PHARMD
Phone: 434-575-0511