Provider Demographics
NPI:1699667048
Name:BUCHANAN, TAJE OMARI
Entity type:Individual
Prefix:
First Name:TAJE
Middle Name:OMARI
Last Name:BUCHANAN
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 PRESIDENTIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-3143
Mailing Address - Country:US
Mailing Address - Phone:757-776-1720
Mailing Address - Fax:
Practice Address - Street 1:665 PRESIDENTIAL BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-3143
Practice Address - Country:US
Practice Address - Phone:757-776-1720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0245016640183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician