=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275659690
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VIRGINIA DEPARTMENT OF HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3130 VICTORIA BLVD
-----------------------------------------------------
City | HAMPTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23661-1544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-727-1172
-----------------------------------------------------
Fax | 757-727-1185
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3130 VICTORIA BLVD
-----------------------------------------------------
City | HAMPTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23661-1544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-727-1172
-----------------------------------------------------
Fax | 757-727-1185
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | MR. JOSEPH EDWARD MANNO
-----------------------------------------------------
Credential | PHARMACIST
-----------------------------------------------------
Telephone | 757-727-1172
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 0202005344
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------