=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235510314
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GARDENS PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2015
-----------------------------------------------------
Last Update Date | 05/31/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1101 EXECUTIVE BLVD SUITE A
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23320-3634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-656-6460
-----------------------------------------------------
Fax | 757-410-1799
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1101 EXECUTIVE BLVD SUITE A
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23320-3634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-656-6460
-----------------------------------------------------
Fax | 757-410-1799
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST IN CHARGE
-----------------------------------------------------
Name | MRS. REBECCA BOYETTE CRAVEN
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 757-567-0798
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 0201004651
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------