Healthcare Provider Details

I. General information

NPI: 1083324859
Provider Name (Legal Business Name): DENA KOTA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 PROFESSIONAL CIR
WILLIAMSBURG VA
23185-3374
US

IV. Provider business mailing address

104 JUBAL PL
WILLIAMSBURG VA
23185-6503
US

V. Phone/Fax

Practice location:
  • Phone: 757-345-2071
  • Fax:
Mailing address:
  • Phone: 757-207-6346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number0202218941
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: