Provider Demographics
NPI:1376292334
Name:KEMPSVILLE BEHAVIORAL HEALTH PHARMACY
Entity Type:Organization
Organization Name:KEMPSVILLE BEHAVIORAL HEALTH PHARMACY
Other - Org Name:KEMPSVILLE BEHAVIORAL HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-382-3319
Mailing Address - Street 1:860 KEMPSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502
Mailing Address - Country:US
Mailing Address - Phone:757-455-0325
Mailing Address - Fax:757-455-0301
Practice Address - Street 1:860 KEMPSVILLE RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502
Practice Address - Country:US
Practice Address - Phone:757-455-0325
Practice Address - Fax:757-455-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-18
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0200XPharmacy Service ProvidersPharmacistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0201004995OtherSTATE PERMIT