Provider Demographics
NPI:1063802817
Name:FARNAM, ALLISON
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:FARNAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4554 VIRGINIA BEACH BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3045
Mailing Address - Country:US
Mailing Address - Phone:757-451-7661
Mailing Address - Fax:757-451-7671
Practice Address - Street 1:4554 VIRGINIA BEACH BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3045
Practice Address - Country:US
Practice Address - Phone:757-451-7661
Practice Address - Fax:757-451-7671
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230012263183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician