Provider Demographics
NPI:1629774971
Name:PULLER VETERANS CARE CENTER
Entity Type:Organization
Organization Name:PULLER VETERANS CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BANISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:826-212-0410
Mailing Address - Street 1:PULLER VETERANS CARE CENTER
Mailing Address - Street 2:6951 VINT HILL PKWY
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20187
Mailing Address - Country:US
Mailing Address - Phone:826-212-0410
Mailing Address - Fax:
Practice Address - Street 1:6951 VINT HILL PARKWAY
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20191
Practice Address - Country:US
Practice Address - Phone:826-212-0410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PULLER VETERANS CARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy