Provider Demographics
NPI:1366734212
Name:RECTORS & VISITORS OF THE UNIVERSITY OF VIRGINIA
Entity type:Organization
Organization Name:RECTORS & VISITORS OF THE UNIVERSITY OF VIRGINIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-243-9308
Mailing Address - Street 1:590 PETER JEFFERSON PKWY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-4628
Mailing Address - Country:US
Mailing Address - Phone:434-982-6893
Mailing Address - Fax:434-982-8420
Practice Address - Street 1:590 PETER JEFFERSON PKWY
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-4628
Practice Address - Country:US
Practice Address - Phone:434-982-6893
Practice Address - Fax:434-982-8420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336S0011X
VA02010044163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4843404OtherNCPDP PROVIDER IDENTIFICATION NUMBER