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General NPI Number Information
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NPI Number | 1316249865
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Entity Type | Individual
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Provider Name | KERRY FAIN BRISCO
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Gender | Female
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Dates
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Enumeration Date | 12/03/2010
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Last Update Date | 12/03/2010
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Provider Practice Location Address
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Address Line | 903 UNIVERSITY CITY BLVD
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City | BLACKSBURG
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State | VA
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Zip | 24060-2709
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Country | US
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Telephone | 540-951-4136
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Fax |
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Provider Business Mailing Address
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Address Line | 910 CARSON DR
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City | CHRISTIANSBURG
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State | VA
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Zip | 24073-5410
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Country | US
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Telephone | 540-230-0286
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 0202010026
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License Number State | VA
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