Provider Demographics
NPI:1417551672
Name:EMERSON, EUGENE DAVID (RPH)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:DAVID
Last Name:EMERSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 RIVERSTONE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-6390
Mailing Address - Country:US
Mailing Address - Phone:804-402-7522
Mailing Address - Fax:
Practice Address - Street 1:11120 PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-5028
Practice Address - Country:US
Practice Address - Phone:804-740-0238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009646183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist