Provider Demographics
NPI:1679798813
Name:VANDERGRIFT RYLAND, MARLA
Entity Type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:
Last Name:VANDERGRIFT RYLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 FLOYD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-2711
Mailing Address - Country:US
Mailing Address - Phone:804-355-2553
Mailing Address - Fax:
Practice Address - Street 1:5201 CHIPPENHAM CROSSING CTR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23234-6901
Practice Address - Country:US
Practice Address - Phone:804-714-0687
Practice Address - Fax:804-714-0712
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009794183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist