Provider Demographics
NPI:1891728440
Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEAWILL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:804-786-4326
Mailing Address - Street 1:PO BOX 2448
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23218-2448
Mailing Address - Country:US
Mailing Address - Phone:804-786-1652
Mailing Address - Fax:804-371-0236
Practice Address - Street 1:101 N 14TH ST
Practice Address - Street 2:MONROE BLDG., ROOM S-45
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-3665
Practice Address - Country:US
Practice Address - Phone:804-786-1652
Practice Address - Fax:804-371-0236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201000080333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2125539OtherPK