Provider Demographics
NPI:1881061166
Name:VANCE, DAVID (PHARMD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:VANCE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 BEN BOLT AVE
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24651-9700
Mailing Address - Country:US
Mailing Address - Phone:276-385-0584
Mailing Address - Fax:276-988-0517
Practice Address - Street 1:141 BEN BOLT AVE
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24651-9700
Practice Address - Country:US
Practice Address - Phone:276-385-0584
Practice Address - Fax:276-988-0517
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211556183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist