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General NPI Number Information
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NPI Number | 1932267804
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Entity Type | Individual
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Provider Name | JOEL DIRECTO GUTIERREZ PHARMD
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Gender | Male
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 06/28/2018
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Provider Practice Location Address
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Address Line | 224 GREAT BRIDGE BLVD STE 161B
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City | CHESAPEAKE
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State | VA
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Zip | 23320
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Country | US
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Telephone | 757-547-2247
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Fax | 757-547-2244
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Provider Business Mailing Address
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Address Line | 444 BLUE BEECH WAY
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City | CHESAPEAKE
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State | VA
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Zip | 23320-3812
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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 | 0202207576
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License Number State | VA
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