Provider Demographics
NPI:1972593218
Name:PATINA, AMY BATEMAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BATEMAN
Last Name:PATINA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9115 BERKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-3801
Mailing Address - Country:US
Mailing Address - Phone:804-789-0998
Mailing Address - Fax:
Practice Address - Street 1:400 LIBBIE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2616
Practice Address - Country:US
Practice Address - Phone:804-285-8618
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202012962183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist