Provider Demographics
NPI:1548860927
Name:VANCE, TINA RENEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:RENEE
Last Name:VANCE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8691
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23450-8691
Mailing Address - Country:US
Mailing Address - Phone:304-633-5128
Mailing Address - Fax:
Practice Address - Street 1:632 GRASSFIELD PKWY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-7449
Practice Address - Country:US
Practice Address - Phone:757-312-9375
Practice Address - Fax:757-312-9401
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202212409183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist