Healthcare Provider Details

I. General information

NPI: 1720341290
Provider Name (Legal Business Name): APPOMATTOX DRUGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 10/03/2013
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

21414 CHESTERFIELD AVE
SOUTH CHESTERFIELD VA
23803-2408
US

V. Phone/Fax

Practice location:
  • Phone: 804-520-4282
  • Fax: 804-520-4285
Mailing address:
  • Phone: 804-520-4282
  • Fax: 804-520-4285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. BRENDA ALLEN EPPS
Title or Position: OWNER PHARMACIST
Credential: RPH
Phone: 804-469-9139