Provider Demographics
NPI:1306470240
Name:TOLLEY, ALEXANDER SCOTT (PHARMD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:SCOTT
Last Name:TOLLEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 GARRISONVILLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-1592
Mailing Address - Country:US
Mailing Address - Phone:640-657-0006
Mailing Address - Fax:
Practice Address - Street 1:418 GARRISONVILLE RD STE 100
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1592
Practice Address - Country:US
Practice Address - Phone:640-657-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-01
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202218063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist