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General NPI Number Information
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NPI Number | 1447838750
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Entity Type | Organization
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Legal Business Name | UPPER MATTAPONI INDIAN TRIBE
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Dates
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Enumeration Date | 03/30/2021
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | 7864 RICHMOND TAPPAHANNOCK HWY
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City | AYLETT
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State | VA
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Zip | 23009-3056
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Country | US
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Telephone | 804-769-2015
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Fax |
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Provider Business Mailing Address
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Address Line | 13476 KING WILLIAM RD
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City | KING WILLIAM
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State | VA
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Zip | 23086-3401
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Country | US
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Telephone | 804-769-0041
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | STEVE TUPPONCE
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Credential |
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Telephone | 804-347-4109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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