Provider Demographics
NPI:1285222737
Name:TAWA, VIRGINIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:TAWA
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 1:14 WINDEMERE DR
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-2024
Mailing Address - Country:US
Mailing Address - Phone:978-274-2305
Mailing Address - Fax:
Practice Address - Street 1:1212 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3095
Practice Address - Country:US
Practice Address - Phone:978-369-3100
Practice Address - Fax:978-371-1618
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH25663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist