Provider Demographics
NPI:1154975704
Name:KIRK, DEAN FRANKLIN JR (RPH)
Entity type:Individual
Prefix:MR
First Name:DEAN
Middle Name:FRANKLIN
Last Name:KIRK
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 COMMONWEALTH DR
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-4051
Mailing Address - Country:US
Mailing Address - Phone:276-679-7340
Mailing Address - Fax:276-679-7330
Practice Address - Street 1:780 COMMONWEALTH DR
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-4051
Practice Address - Country:US
Practice Address - Phone:276-679-7340
Practice Address - Fax:276-679-7330
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202012135183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202012135OtherVA BOARD OF PHARMACY LICENSE NUMBER