MEDICARE: MS. VIRGINIA BURTON UPDEGRAVE RPH, BCPP

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	1835P1300X	Psychiatric Pharmacist	11309	NC

General Provider Information

NPI Number	:	1477568244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VIRGINIA BURTON UPDEGRAVE RPH, BCPP

Provider Business Mailing Address
First Line	:	1401 W ASH ST
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27530-1078
Country	:	US
Telephone Number	:	919-947-8160
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 W ASH ST
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27530-1078
Country	:	US
Telephone Number	:	919-947-8160
Fax Number	:

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

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	04/26/2017

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