Basic Information
| Provider Information | |||||||||
| NPI: | 1659959880 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VANIER | ||||||||
| FirstName: | JUNE | ||||||||
| MiddleName: | DOLORES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3673 GATEWAY DR APT 1D | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 237035101 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1832 KEMPSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234646861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572782573 | ||||||||
| FaxNumber: | 7572782567 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2021 | ||||||||
| LastUpdateDate: | 03/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183700000X | 0230023772 | VA | Y | Pharmacy Service Providers | Pharmacy Technician |
No ID Information.