Provider Demographics
NPI:1861901340
Name:PERSONALMED VIRGINIA PHARMACY SERVICES
Entity type:Organization
Organization Name:PERSONALMED VIRGINIA PHARMACY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP MANAGED CARE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DELFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:DOHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, PHD, MPH
Authorized Official - Phone:844-901-7832
Mailing Address - Street 1:10370 RICHMOND AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-4141
Mailing Address - Country:US
Mailing Address - Phone:844-901-7832
Mailing Address - Fax:281-305-3989
Practice Address - Street 1:12007 SUNRISE VALLEY DR STE 110
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3460
Practice Address - Country:US
Practice Address - Phone:844-901-7832
Practice Address - Fax:281-305-3989
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERSONALMED LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-27
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy