Provider Demographics
NPI:1689996480
Name:VLADIMERY, PETER (RPH)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:VLADIMERY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12872 RIVER MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266-4484
Mailing Address - Country:US
Mailing Address - Phone:276-873-5171
Mailing Address - Fax:
Practice Address - Street 1:12872 RIVER MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266-4484
Practice Address - Country:US
Practice Address - Phone:276-873-5171
Practice Address - Fax:304-324-4208
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-20
Last Update Date:2010-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207249183500000X
WVRP0002983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist