Provider Demographics
NPI:1245202571
Name:BIRKENMAIER, JOE (BS)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:BIRKENMAIER
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 NIDER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23521-2700
Mailing Address - Country:US
Mailing Address - Phone:757-314-7391
Mailing Address - Fax:
Practice Address - Street 1:1030 NIDER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23521-2700
Practice Address - Country:US
Practice Address - Phone:757-314-7391
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006008183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA18OtherPHARMACIST