Healthcare Provider Details

I. General information

NPI: 1083539449
Provider Name (Legal Business Name): ANDY SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 INDEPENDENCE BLVD
VIRGINIA BEACH VA
23455-4042
US

IV. Provider business mailing address

749 BIG BEAR LN
CHESAPEAKE VA
23323-1470
US

V. Phone/Fax

Practice location:
  • Phone: 757-460-2607
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0230044715
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: