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General NPI Number Information
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NPI Number | 1063590073
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Entity Type | Organization
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Legal Business Name | PENINSULA HEALTH CENTER PHARMACY
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 416 J CLYDE MORRIS BLVD
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City | NEWPORT NEWS
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State | VA
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Zip | 23601
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Country | US
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Telephone | 757-594-7431
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Fax | 757-594-7199
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Provider Business Mailing Address
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Address Line | 416 J CLYDE MORRIS BLVD
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City | NEWPORT NEWS
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State | VA
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Zip | 23601
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Country | US
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Telephone | 757-594-7431
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Fax | 757-594-7199
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Authorized Official
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Title or Position | DISTRICT HEALTH DIRECTOR
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Name | DR. DAVID HASKELL TRUMP
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Credential | MD MPH
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Telephone | 757-594-7305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 0201000510
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License Number State | VA
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