MEDICARE: SALLY EBY PHARMACIST

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	0202006637	VA

General Provider Information

NPI Number	:	1528737533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY EBY PHARMACIST

Provider Business Mailing Address
First Line	:	1965 OAKLAND DR
Second Line	:
City	:	MAIDENS
State	:	VA
Zip	:	23102-2236
Country	:	US
Telephone Number	:	804-556-5542
Fax Number	:

Provider Business Practice Location Address
First Line	:	3656 MAYLAND CT
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23233-1409
Country	:	US
Telephone Number	:	804-897-6447
Fax Number	:	804-897-6449

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

Provider Enumeration Date	:	09/13/2021
Last Update Date	:	09/13/2021

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Directions to “ SALLY EBY PHARMACIST” Practice Location

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