Provider Demographics
NPI:1770170755
Name:PIDROUTCHNIAK, ILIA (RPH)
Entity type:Individual
Prefix:MR
First Name:ILIA
Middle Name:
Last Name:PIDROUTCHNIAK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4004 BUCK RUN CT
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:VA
Mailing Address - Zip Code:22802-1172
Mailing Address - Country:US
Mailing Address - Phone:434-299-2244
Mailing Address - Fax:
Practice Address - Street 1:1380 LITTLE SORRELL DR
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-7372
Practice Address - Country:US
Practice Address - Phone:540-214-5035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-24
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202218068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist