Provider Demographics
NPI:1285335026
Name:WRIGHT, MICHAEL MAXIMUM
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MAXIMUM
Last Name:WRIGHT
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 1:103 SLEEPY HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23692-2143
Mailing Address - Country:US
Mailing Address - Phone:757-777-5988
Mailing Address - Fax:
Practice Address - Street 1:5500 GEORGE WASHINGTON MEM HWY
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23692-2764
Practice Address - Country:US
Practice Address - Phone:757-898-5466
Practice Address - Fax:757-833-3726
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230036940183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician