Healthcare Provider Details

I. General information

NPI: 1528283314
Provider Name (Legal Business Name): GLORYERS A HARRIS-DANIELS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5036 FERRELL PKWY
VIRGINIA BEACH VA
23464-8867
US

IV. Provider business mailing address

2901 BALD EAGLE BND
VIRGINIA BEACH VA
23453-7067
US

V. Phone/Fax

Practice location:
  • Phone: 757-495-3088
  • Fax: 757-495-6581
Mailing address:
  • Phone: 757-377-1176
  • Fax: 757-368-0667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number02029547
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: