Provider Demographics
NPI:1043594880
Name:OVERTON-WYNN, TWYANDA CHERICE (RPH, MBA)
Entity Type:Individual
Prefix:MRS
First Name:TWYANDA
Middle Name:CHERICE
Last Name:OVERTON-WYNN
Suffix:
Gender:F
Credentials:RPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 ARBOR RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-2158
Mailing Address - Country:US
Mailing Address - Phone:804-317-6031
Mailing Address - Fax:
Practice Address - Street 1:1340 ARBOR RIDGE LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-2158
Practice Address - Country:US
Practice Address - Phone:804-317-6031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist