Healthcare Provider Details

I. General information

NPI: 1053684266
Provider Name (Legal Business Name): BRENDA EPPS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2012
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21414 CHESTERFIELD AVE
SOUTH CHESTERFIELD VA
23803-2408
US

IV. Provider business mailing address

23801 WILLIAMSON RD
DINWIDDIE VA
23841-3317
US

V. Phone/Fax

Practice location:
  • Phone: 804-469-9139
  • Fax: 804-469-9139
Mailing address:
  • Phone: 804-469-9139
  • Fax: 804-469-9139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202005189
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: