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General NPI Number Information
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NPI Number | 1023139714
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Entity Type | Organization
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Legal Business Name | CAVALIER PHARMA GROUP INC
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 425 W WASHINGTON ST
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City | SUFFOLK
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State | VA
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Zip | 23434-5320
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Country | US
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Telephone | 757-925-2014
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Fax |
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Provider Business Mailing Address
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Address Line | 425 W WASHINGTON ST
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City | SUFFOLK
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State | VA
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Zip | 23434-5320
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Country | US
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Telephone | 757-925-2014
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Fax |
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Authorized Official
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Title or Position | PRES
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Name | MR. WILLIAM LOUIS TATUM JR.
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Credential |
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Telephone | 757-925-2014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0201002458
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License Number State | VA
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