MEDICARE: MR. GYSBERT SAMUEL DUPLESSIS RPH

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	0202204598	VA

General Provider Information

NPI Number	:	1063793768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GYSBERT SAMUEL DUPLESSIS RPH

Provider Business Mailing Address
First Line	:	1101 NIMMO PKWY
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-7730
Country	:	US
Telephone Number	:	757-427-1655
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 NIMMO PKWY
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-7730
Country	:	US
Telephone Number	:	757-427-1655
Fax Number	:

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

Provider Enumeration Date	:	09/08/2011
Last Update Date	:	09/12/2024

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