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General NPI Number Information
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NPI Number | 1982178166
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Entity Type | Individual
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Provider Name | BARBARA VAILLANCOURT
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Gender | Female
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Dates
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Enumeration Date | 01/22/2019
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Last Update Date | 11/24/2020
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Provider Practice Location Address
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Address Line | 12720 MCMANUS BLVD STE 100
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City | NEWPORT NEWS
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State | VA
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Zip | 23602-4441
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Country | US
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Telephone | 757-947-3740
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Fax | 757-947-3745
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Provider Business Mailing Address
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Address Line | 208 SCHOOL LN
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City | YORKTOWN
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State | VA
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Zip | 23692-3206
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Country | US
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Telephone | 757-890-1369
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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 | 0202010014
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License Number State | VA
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