Provider Demographics
NPI:1386249803
Name:PAGADUAN, JOHN RICK SANTANA (PHARM D)
Entity type:Individual
Prefix:
First Name:JOHN RICK
Middle Name:SANTANA
Last Name:PAGADUAN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:PAGADUAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:1701 INDEPENDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-4042
Mailing Address - Country:US
Mailing Address - Phone:757-460-2607
Mailing Address - Fax:757-464-1345
Practice Address - Street 1:1701 INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-4042
Practice Address - Country:US
Practice Address - Phone:757-460-2607
Practice Address - Fax:757-464-1345
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202213315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist