Provider Demographics
NPI:1497357248
Name:FITZGERALD, VICKI LEE (RPH)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LEE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 FILBERT ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4408
Mailing Address - Country:US
Mailing Address - Phone:757-617-9508
Mailing Address - Fax:
Practice Address - Street 1:2089 SALEM RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-1309
Practice Address - Country:US
Practice Address - Phone:757-471-2202
Practice Address - Fax:757-471-2210
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202012509183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist