Provider Demographics
NPI:1235510314
Name:GARDENS PHARMACY
Entity type:Organization
Organization Name:GARDENS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:BOYETTE
Authorized Official - Last Name:CRAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:757-567-0798
Mailing Address - Street 1:1101 EXECUTIVE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3634
Mailing Address - Country:US
Mailing Address - Phone:757-656-6460
Mailing Address - Fax:757-410-1799
Practice Address - Street 1:1101 EXECUTIVE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3634
Practice Address - Country:US
Practice Address - Phone:757-656-6460
Practice Address - Fax:757-410-1799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-15
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010046513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0201004651OtherSTATE PERMIT NUMBER