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General NPI Number Information
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NPI Number | 1366482382
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Entity Type | Organization
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Legal Business Name | PENINSULA INSTITUTE FOR COMMUNITY HEALTH
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1033 28TH ST 2ND FLOOR
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City | NEWPORT NEWS
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State | VA
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Zip | 23607-4233
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Country | US
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Telephone | 757-952-0176
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Fax | 757-952-0181
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Provider Business Mailing Address
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Address Line | 1033 28TH ST 2ND FLOOR
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City | NEWPORT NEWS
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State | VA
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Zip | 23607-4233
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Country | US
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Telephone | 757-952-0176
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Fax | 757-952-0181
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | ANGELA FUTRELL
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Credential |
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Telephone | 757-591-0643
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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 |
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License Number State |
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