Provider Demographics
NPI:1679842819
Name:MARGETAK, PAGE
Entity Type:Individual
Prefix:
First Name:PAGE
Middle Name:
Last Name:MARGETAK
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 1:112 BROWNS WAY RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-9507
Mailing Address - Country:US
Mailing Address - Phone:804-897-0977
Mailing Address - Fax:
Practice Address - Street 1:112 BROWNS WAY RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-9507
Practice Address - Country:US
Practice Address - Phone:804-897-0977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist