Provider Demographics
NPI:1578830741
Name:ALEXANDER, DIEDRA LASHALLE (RPH)
Entity type:Individual
Prefix:MRS
First Name:DIEDRA
Middle Name:LASHALLE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2924 CHAMBERLAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23222-3506
Mailing Address - Country:US
Mailing Address - Phone:804-321-7068
Mailing Address - Fax:804-321-7498
Practice Address - Street 1:2924 CHAMBERLAYNE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-3506
Practice Address - Country:US
Practice Address - Phone:804-321-7068
Practice Address - Fax:804-321-7498
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23515183500000X
VA0202210526183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist