Provider Demographics
NPI:1477837359
Name:KIRK, CHAD MICHAEL (RP H)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:MICHAEL
Last Name:KIRK
Suffix:
Gender:M
Credentials:RP H
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2529 NESTLEBROOK TRL
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-8298
Mailing Address - Country:US
Mailing Address - Phone:757-301-2828
Mailing Address - Fax:
Practice Address - Street 1:5237 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4201
Practice Address - Country:US
Practice Address - Phone:757-495-3016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202204396183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist