Provider Demographics
NPI:1669757910
Name:CHILDRESS, URATCHADHA SISAITHONG (PHARMD)
Entity type:Individual
Prefix:DR
First Name:URATCHADHA
Middle Name:SISAITHONG
Last Name:CHILDRESS
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 1:2418 GEORGE WASHINGTON MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:HAYES
Mailing Address - State:VA
Mailing Address - Zip Code:23072-3566
Mailing Address - Country:US
Mailing Address - Phone:804-642-5810
Mailing Address - Fax:
Practice Address - Street 1:2418 GEORGE WASHINGTON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:HAYES
Practice Address - State:VA
Practice Address - Zip Code:23072-3566
Practice Address - Country:US
Practice Address - Phone:804-642-5810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208190183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist