Provider Demographics
NPI:1699255703
Name:SPROUSE, CHELSEA (PHARMD)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:SPROUSE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 GLENDON RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-5454
Mailing Address - Country:US
Mailing Address - Phone:540-597-7013
Mailing Address - Fax:
Practice Address - Street 1:72 KINGSTON DR
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24083-2574
Practice Address - Country:US
Practice Address - Phone:540-992-1291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA020221685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist