Provider Demographics
NPI:1457011876
Name:IRVINE, TATIANA MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:MARIE
Last Name:IRVINE
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 1:519 FRONT ST APT 401
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1003
Mailing Address - Country:US
Mailing Address - Phone:808-690-3735
Mailing Address - Fax:
Practice Address - Street 1:2040 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23324-3004
Practice Address - Country:US
Practice Address - Phone:757-543-9632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202220081183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist