Provider Demographics
NPI:1396213526
Name:DELAPP, VICTOR BURNELL
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:BURNELL
Last Name:DELAPP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PHARMACY DEPARTMENT
Mailing Address - Street 2:1906 BELLEVIEW AVENUE
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014
Mailing Address - Country:US
Mailing Address - Phone:540-981-8556
Mailing Address - Fax:540-266-5828
Practice Address - Street 1:PHARMACY DEPARTMENT
Practice Address - Street 2:1906 BELLEVIEW AVENUE
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014
Practice Address - Country:US
Practice Address - Phone:540-981-8556
Practice Address - Fax:540-266-5828
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02020130261835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist