Provider Demographics
NPI:1376850941
Name:CARPENTER, THERESA (PHARMD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:CARPENTER
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 1:3653 VIRGINIA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-3418
Mailing Address - Country:US
Mailing Address - Phone:757-463-2011
Mailing Address - Fax:757-498-8532
Practice Address - Street 1:3653 VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-3418
Practice Address - Country:US
Practice Address - Phone:757-463-2011
Practice Address - Fax:757-498-8532
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208075183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist