Provider Demographics
NPI:1588945547
Name:WILLIAMS-CANNADY, REVA JEANETTE (RPH)
Entity type:Individual
Prefix:
First Name:REVA
Middle Name:JEANETTE
Last Name:WILLIAMS-CANNADY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVAL MEDICAL CENTER PORTSMOUTH
Mailing Address - Street 2:620 JOHN PAUL JONES CIRCLE
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23708
Mailing Address - Country:US
Mailing Address - Phone:757-953-0258
Mailing Address - Fax:757-953-0865
Practice Address - Street 1:620 JOHN PAUL JONES CIR STE 275
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2113
Practice Address - Country:US
Practice Address - Phone:757-953-0258
Practice Address - Fax:757-953-0865
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202007311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist