Healthcare Provider Details

I. General information

NPI: 1376850941
Provider Name (Legal Business Name): THERESA CARPENTER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3653 VIRGINIA BEACH BLVD
VIRGINIA BEACH VA
23452-3418
US

IV. Provider business mailing address

3653 VIRGINIA BEACH BLVD
VIRGINIA BEACH VA
23452-3418
US

V. Phone/Fax

Practice location:
  • Phone: 757-463-2011
  • Fax: 757-498-8532
Mailing address:
  • Phone: 757-463-2011
  • Fax: 757-498-8532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202208075
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: