Provider Demographics
NPI:1841754686
Name:COLEMAN, VIRGINIA VICTORIA (PHARMD)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:VICTORIA
Last Name:COLEMAN
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 1:110 MILITARY DR
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-1921
Mailing Address - Country:US
Mailing Address - Phone:607-768-4078
Mailing Address - Fax:
Practice Address - Street 1:5700 W GENESEE ST STE 106
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-3200
Practice Address - Country:US
Practice Address - Phone:315-468-0897
Practice Address - Fax:315-488-4789
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057859183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist