Basic Information
| Provider Information | |||||||||
| NPI: | 1679151088 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEBSTER | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13325 ROSSINGTON PL | ||||||||
| Address2: | |||||||||
| City: | CHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238317161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8043182688 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5700 HOPKINS RD | ||||||||
| Address2: | |||||||||
| City: | NORTH CHESTERFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232346631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042530759 | ||||||||
| FaxNumber: | 8042539788 | ||||||||
| 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 | 0230016245 | VA | Y | Pharmacy Service Providers | Pharmacy Technician |
No ID Information.