MEDICARE: REVA JEANETTE WILLIAMS-CANNADY 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	0202007311	VA

General Provider Information

NPI Number	:	1588945547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REVA JEANETTE WILLIAMS-CANNADY RPH

Provider Business Mailing Address
First Line	:	NAVAL MEDICAL CENTER PORTSMOUTH
Second Line	:	620 JOHN PAUL JONES CIRCLE
City	:	PORTSMOUTH
State	:	VA
Zip	:	23708
Country	:	US
Telephone Number	:	757-953-0258
Fax Number	:	757-953-0865

Provider Business Practice Location Address
First Line	:	620 JOHN PAUL JONES CIR STE 275
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23708-2113
Country	:	US
Telephone Number	:	757-953-0258
Fax Number	:	757-953-0865

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

Provider Enumeration Date	:	09/06/2011
Last Update Date	:	05/14/2021

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