Provider Demographics
NPI:1093032401
Name:PROSEK, DEBORAH D (RPH)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:D
Last Name:PROSEK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 MILL STREAM WAY
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3192
Mailing Address - Country:US
Mailing Address - Phone:757-903-8311
Mailing Address - Fax:
Practice Address - Street 1:118 WALLER MILL RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2946
Practice Address - Country:US
Practice Address - Phone:757-220-2394
Practice Address - Fax:757-220-4675
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-24
Last Update Date:2010-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202012850183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist