Provider Demographics
NPI:1972820744
Name:HEDGES, ROSALYN OTELIA (RPH)
Entity Type:Individual
Prefix:MS
First Name:ROSALYN
Middle Name:OTELIA
Last Name:HEDGES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 SOUTHGATE SQ
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-3603
Mailing Address - Country:US
Mailing Address - Phone:804-520-5150
Mailing Address - Fax:804-524-2259
Practice Address - Street 1:116 SOUTHGATE SQ
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-3603
Practice Address - Country:US
Practice Address - Phone:804-520-5150
Practice Address - Fax:804-524-2259
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202010058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist