Provider Demographics
NPI:1730579210
Name:SMITH, VIRGINIA ROSE (CPHT)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ROSE
Last Name:SMITH
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:ROSE
Other - Last Name:AMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPHT
Mailing Address - Street 1:403 CONSTANT FRIENDSHIP BLVD
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-2566
Mailing Address - Country:US
Mailing Address - Phone:410-670-9001
Mailing Address - Fax:443-409-3125
Practice Address - Street 1:403 CONSTANT FRIENDSHIP BLVD
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-2566
Practice Address - Country:US
Practice Address - Phone:410-670-9001
Practice Address - Fax:443-409-3125
Is Sole Proprietor?:No
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT05786183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD520107010101751OtherPTCB
MDT05786OtherMARYLAND LICENSE