Provider Demographics
NPI:1750702007
Name:PLUM, MARY-BETH FENNELL (PHARMD, BCACP)
Entity type:Individual
Prefix:
First Name:MARY-BETH
Middle Name:FENNELL
Last Name:PLUM
Suffix:
Gender:F
Credentials:PHARMD, BCACP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7007 HARBOUR VIEW BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-2719
Mailing Address - Country:US
Mailing Address - Phone:757-353-9800
Mailing Address - Fax:757-215-2729
Practice Address - Street 1:7007 HARBOUR VIEW BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2719
Practice Address - Country:US
Practice Address - Phone:757-353-9800
Practice Address - Fax:757-215-2729
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA02020128651835P0018X
PARP-043692-L1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist