Healthcare Provider Details

I. General information

NPI: 1992025696
Provider Name (Legal Business Name): MARIANNE DU PLESSIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 N GREAT NECK RD
VIRGINIA BEACH VA
23454-2268
US

IV. Provider business mailing address

2340 TIERRA MONTE ARCH
VIRGINIA BEACH VA
23456-6761
US

V. Phone/Fax

Practice location:
  • Phone: 757-481-5001
  • Fax: 757-481-4970
Mailing address:
  • Phone: 757-426-0388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202206411
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: