Provider Demographics
NPI:1942612098
Name:TARGET
Entity Type:Organization
Organization Name:TARGET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FEMINELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-520-2280
Mailing Address - Street 1:721 SOUTHPARK BLVD
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-3606
Mailing Address - Country:US
Mailing Address - Phone:804-520-2280
Mailing Address - Fax:804-431-3211
Practice Address - Street 1:721 SOUTHPARK BLVD
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-3606
Practice Address - Country:US
Practice Address - Phone:804-520-2280
Practice Address - Fax:804-431-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209760251S00000X
FLPS43913251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS43913OtherBOARD OF PHARMACY LICENSE
VA0202209760OtherBOARD OF PHARMACY LICENSE