=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083878870
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALICIA ELIZABETH HUBBARD PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2008
-----------------------------------------------------
Last Update Date | 09/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7001 LANKFORD HWY
-----------------------------------------------------
City | OAK HALL
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23416-2223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-824-4477
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7001 LANKFORD HWY
-----------------------------------------------------
City | OAK HALL
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23416-2223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-824-4011
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 0202215944
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 0202215944
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------