Provider Demographics
NPI:1497359756
Name:VAN ARSDALE, SYDNEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:VAN ARSDALE
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 1:4126 PLANTATION RD NE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-3136
Mailing Address - Country:US
Mailing Address - Phone:540-563-4968
Mailing Address - Fax:540-563-4871
Practice Address - Street 1:4126 PLANTATION RD NE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-3136
Practice Address - Country:US
Practice Address - Phone:540-563-4968
Practice Address - Fax:540-568-4871
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202215377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist