Provider Demographics
NPI:1366727307
Name:LONDON, DEBORAH J (RPH MBA)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:J
Last Name:LONDON
Suffix:
Gender:F
Credentials:RPH MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 GLENROCK RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3702
Mailing Address - Country:US
Mailing Address - Phone:757-459-4480
Mailing Address - Fax:757-461-4840
Practice Address - Street 1:850 GLENROCK RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3702
Practice Address - Country:US
Practice Address - Phone:757-459-4480
Practice Address - Fax:757-461-4840
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006141183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist