Healthcare Provider Details

I. General information

NPI: 1467039628
Provider Name (Legal Business Name): TABITHA SESSOMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4670 CASEY BLVD
WILLIAMSBURG VA
23188-2879
US

IV. Provider business mailing address

4670 CASEY BLVD
WILLIAMSBURG VA
23188-2879
US

V. Phone/Fax

Practice location:
  • Phone: 757-603-4607
  • Fax: 757-603-4601
Mailing address:
  • Phone: 757-603-4607
  • Fax: 757-603-4601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0230024099
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: