Provider Demographics
NPI:1154709681
Name:DRAEGER, VIRGINIA ANN MOORE (PHARMD)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ANN MOORE
Last Name:DRAEGER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:ANN
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:757 WESTWOOD PLZ
Mailing Address - Street 2:RRUCMC ROOM # B531
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-7423
Mailing Address - Country:US
Mailing Address - Phone:310-206-4400
Mailing Address - Fax:310-825-2257
Practice Address - Street 1:662 GAYLEY AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-7423
Practice Address - Country:US
Practice Address - Phone:310-267-8500
Practice Address - Fax:310-267-3644
Is Sole Proprietor?:No
Enumeration Date:2015-05-17
Last Update Date:2015-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 31459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist