Provider Demographics
NPI:1942801485
Name:TAKAHASHI, KEI
Entity Type:Individual
Prefix:
First Name:KEI
Middle Name:
Last Name:TAKAHASHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 HULL ST APT 4L
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-4275
Mailing Address - Country:US
Mailing Address - Phone:757-617-1379
Mailing Address - Fax:
Practice Address - Street 1:1950 ANDERSON HWY
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-7918
Practice Address - Country:US
Practice Address - Phone:804-464-9894
Practice Address - Fax:804-464-9888
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202215169183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist