Healthcare Provider Details

I. General information

NPI: 1902177728
Provider Name (Legal Business Name): JOHN VAN PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 VIRGINIA BEACH BLVD
VIRGINIA BEACH VA
23452-5617
US

IV. Provider business mailing address

3330 VIRGINIA BEACH BLVD
VIRGINIA BEACH VA
23452-5617
US

V. Phone/Fax

Practice location:
  • Phone: 757-486-4184
  • Fax: 757-486-2468
Mailing address:
  • Phone: 757-486-4184
  • Fax: 757-486-2468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0202212124
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: