MEDICARE: VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM AUTHORITY

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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1558206383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM AUTHORITY

Provider Business Mailing Address
First Line	:	PO BOX 786041
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19178-6041
Country	:	US
Telephone Number	:	804-828-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1330 N 25TH ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-5243
Country	:	US
Telephone Number	:	804-537-0103
Fax Number	:

Authorized Official
Title or Position	:	FACILITY ENROLLMENT SUPERVISOR
Name	:	SANDRA NOEL
Credential	:
Telephone Number	:	804-828-5009

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	05/20/2026

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