Provider Demographics
NPI:1437478419
Name:GRUBB, CHARLOTTE L (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:L
Last Name:GRUBB
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3198 PACIFIC AVE STE 124
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-2949
Mailing Address - Country:US
Mailing Address - Phone:757-482-8309
Mailing Address - Fax:757-546-3290
Practice Address - Street 1:3198 PACIFIC AVE STE 124
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-2949
Practice Address - Country:US
Practice Address - Phone:757-482-8309
Practice Address - Fax:757-546-3290
Is Sole Proprietor?:No
Enumeration Date:2010-05-31
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202010077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist