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General NPI Number Information
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NPI Number | 1629883830
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Entity Type | Individual
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Provider Name | BAELE DETHRIDGE PHARMD
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Gender | Female
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 5917 HIGH ST W
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City | PORTSMOUTH
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State | VA
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Zip | 23703-4505
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Country | US
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Telephone | 757-686-5929
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 ALLENDALE DR APT C
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-5244
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Country | US
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Telephone |
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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 | 0202222538
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License Number State | VA
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