Provider Demographics
NPI:1508844051
Name:POLLARD, CAROLE ANN (CPHT)
Entity Type:Individual
Prefix:MISS
First Name:CAROLE
Middle Name:ANN
Last Name:POLLARD
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26317 WEST WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803
Mailing Address - Country:US
Mailing Address - Phone:804-524-7346
Mailing Address - Fax:804-524-4718
Practice Address - Street 1:26317 WEST WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803
Practice Address - Country:US
Practice Address - Phone:804-524-7346
Practice Address - Fax:804-524-4718
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230004403183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA49-0104Medicaid