Provider Demographics
NPI:1174745616
Name:VIRGINIA COMMONWEATLH UNIVERSITY STUDENT HEALTH PHARMACY
Entity type:Organization
Organization Name:VIRGINIA COMMONWEATLH UNIVERSITY STUDENT HEALTH PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY PIC
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:B
Authorized Official - Last Name:MOOLHUYZEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:804-828-7542
Mailing Address - Street 1:1300 W. BROAD STREET
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23284
Mailing Address - Country:US
Mailing Address - Phone:804-828-7542
Mailing Address - Fax:804-828-1093
Practice Address - Street 1:1300 W. BROAD STREET
Practice Address - Street 2:SUITE 2200
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23284
Practice Address - Country:US
Practice Address - Phone:804-828-7542
Practice Address - Fax:804-828-1093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010023153336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy