Provider Demographics
NPI:1063795342
Name:PEARSON, BARRY
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:
Last Name:PEARSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:857 SOUTH MILITARY HWY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-3548
Mailing Address - Country:US
Mailing Address - Phone:757-424-1752
Mailing Address - Fax:757-424-1837
Practice Address - Street 1:856 S MILITARY HWY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-3548
Practice Address - Country:US
Practice Address - Phone:757-424-1752
Practice Address - Fax:757-424-1837
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005736183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist