=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629414867
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARNESS HEALTH PHARMACY - VIRGINIA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2013
-----------------------------------------------------
Last Update Date | 12/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12720 MCMANUS BLVD STE 100
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23602-4414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-947-3740
-----------------------------------------------------
Fax | 757-947-3745
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12720 MCMANUS BLVD STE 100
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23602-4441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-947-3740
-----------------------------------------------------
Fax | 757-947-3745
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP REIMBURSMENT
-----------------------------------------------------
Name | KIMBERLY M RALSTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 419-996-5119
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 0201004517
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------