MEDICARE: MRS. VICTORIA BLANKENSHIP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	10855	VA

General Provider Information

NPI Number	:	1043587967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICTORIA BLANKENSHIP

Provider Business Mailing Address
First Line	:	1798 N PARHAM RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23229-4654
Country	:	US
Telephone Number	:	804-935-3008
Fax Number	:	804-747-9015

Provider Business Practice Location Address
First Line	:	1798 N PARHAM RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23229-4654
Country	:	US
Telephone Number	:	804-935-3008
Fax Number	:	804-747-9015

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2011
Last Update Date	:	11/21/2011

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