Provider Demographics
NPI:1306128665
Name:WARNER, DELLA JEAN (PHARM,D)
Entity type:Individual
Prefix:
First Name:DELLA
Middle Name:JEAN
Last Name:WARNER
Suffix:
Gender:F
Credentials:PHARM,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 FOUR SEASONS DR
Mailing Address - Street 2:
Mailing Address - City:TROUTVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24175-6497
Mailing Address - Country:US
Mailing Address - Phone:540-591-5807
Mailing Address - Fax:
Practice Address - Street 1:2351 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1111
Practice Address - Country:US
Practice Address - Phone:540-985-6491
Practice Address - Fax:540-985-6497
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202204473183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist