Provider Demographics
NPI:1447847116
Name:KHEM, VICKY
Entity type:Individual
Prefix:DR
First Name:VICKY
Middle Name:
Last Name:KHEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 BLACKWELL RD
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2600
Mailing Address - Country:US
Mailing Address - Phone:540-347-1621
Mailing Address - Fax:540-341-2151
Practice Address - Street 1:510 BLACKWELL RD
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2600
Practice Address - Country:US
Practice Address - Phone:540-347-1621
Practice Address - Fax:540-341-2151
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA020225326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist