Provider Demographics
NPI:1225631369
Name:GALVAN-BERDONCES, BLANCA
Entity Type:Individual
Prefix:MRS
First Name:BLANCA
Middle Name:
Last Name:GALVAN-BERDONCES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6009
Mailing Address - Country:US
Mailing Address - Phone:229-588-0703
Mailing Address - Fax:
Practice Address - Street 1:115 W LITTLE CREEK RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-2512
Practice Address - Country:US
Practice Address - Phone:757-489-5291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy