Provider Demographics
NPI:1194192773
Name:VARNER, VITA (PHARMD)
Entity Type:Individual
Prefix:
First Name:VITA
Middle Name:
Last Name:VARNER
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 38816
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27438-8816
Mailing Address - Country:US
Mailing Address - Phone:646-573-7671
Mailing Address - Fax:
Practice Address - Street 1:1628 HIGHWOODS BLVD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2048
Practice Address - Country:US
Practice Address - Phone:336-455-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-30
Last Update Date:2015-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25548183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist