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General NPI Number Information
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NPI Number | 1548855232
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Entity Type | Individual
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Provider Name | DIANA LYNN BANDURCO RPH
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Gender | Female
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Dates
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Enumeration Date | 03/04/2021
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Last Update Date | 03/04/2021
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Provider Practice Location Address
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Address Line | 10858 BUCKLEY HALL RD
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City | MATHEWS
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State | VA
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Zip | 23109
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Country | US
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Telephone | 804-725-2556
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Fax | 804-725-0786
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Provider Business Mailing Address
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Address Line | 607 CHAPEL NECK RD
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City | NORTH
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State | VA
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Zip | 23128-2009
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Country | US
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Telephone | 804-832-2882
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0202011915
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License Number State | VA
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