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General NPI Number Information
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NPI Number | 1467427286
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Entity Type | Organization
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Legal Business Name | PORT WARWICK MEDICAL ARTS
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Dates
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Enumeration Date | 02/23/2006
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Last Update Date | 08/14/2008
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Provider Practice Location Address
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Address Line | 1031 LOFTIS BOULEVARD
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City | NEWPORT NEWS
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State | VA
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Zip | 23606
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Country | US
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Telephone | 757-736-1221
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 COLISEUM DR PHARMACY DEPARTMENT
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City | HAMPTON
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State | VA
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Zip | 23666-5963
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Country | US
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Telephone | 757-736-1221
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Fax |
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | EDWARD J ELZARIAN
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Credential | RPH
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Telephone | 757-736-1215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 0220000459
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License Number State | VA
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