Provider Demographics
NPI:1598849515
Name:VANDEVENTER, JOHN MILLARD (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MILLARD
Last Name:VANDEVENTER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16053 ROCKY TOP RDG
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24202-4981
Mailing Address - Country:US
Mailing Address - Phone:276-466-3600
Mailing Address - Fax:276-466-3578
Practice Address - Street 1:1883 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3605
Practice Address - Country:US
Practice Address - Phone:276-466-3600
Practice Address - Fax:276-466-3578
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006306183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist