Provider Demographics
NPI:1467734087
Name:PASCHAL, VIRGINIA CLARK (RPH)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:CLARK
Last Name:PASCHAL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:JENNY
Other - Middle Name:CLARK
Other - Last Name:PASCHAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:111 EDGEWOOD SQ
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-2824
Mailing Address - Country:US
Mailing Address - Phone:803-279-1190
Mailing Address - Fax:
Practice Address - Street 1:111 EDGEWOOD SQ
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-2824
Practice Address - Country:US
Practice Address - Phone:803-279-1190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-10
Last Update Date:2011-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist