=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407871957
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEREDYTH COLEMAN NELSON PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 BROAD ROCK BLVD MCGUIRE VA MEDICAL CENTER (119)
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-975-5813
-----------------------------------------------------
Fax | 804-675-5175
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 704 GLENDALE DR
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23229-6410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-765-8474
-----------------------------------------------------
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 | 0202006020
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------