Provider Demographics
NPI:1760173561
Name:WIMES, MARIA GUADALUPE (CPHT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:GUADALUPE
Last Name:WIMES
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 E LITTLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-3824
Mailing Address - Country:US
Mailing Address - Phone:757-588-8694
Mailing Address - Fax:
Practice Address - Street 1:1101 E LITTLE CREEK RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-3824
Practice Address - Country:US
Practice Address - Phone:757-588-8694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002082791183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician