Provider Demographics
NPI:1386215531
Name:HARWELL, VICTORIA CALLIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:CALLIE
Last Name:HARWELL
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 1:1513 WALNUT TREE DR
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-7014
Mailing Address - Country:US
Mailing Address - Phone:704-928-5597
Mailing Address - Fax:
Practice Address - Street 1:2202 WAYNE MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-1724
Practice Address - Country:US
Practice Address - Phone:919-739-5539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist