Provider Demographics
NPI:1477157519
Name:HORTON, ELEANOR W
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:W
Last Name:HORTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-5825
Mailing Address - Country:US
Mailing Address - Phone:540-951-8598
Mailing Address - Fax:540-961-1796
Practice Address - Street 1:1775 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-5825
Practice Address - Country:US
Practice Address - Phone:540-951-8598
Practice Address - Fax:540-961-1796
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011843183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist