Nellie C Street, RPH
Individual provider Active NPI Pharmacist · Lebanon, VA
NPI 1679650352 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1679650352
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 0202010455 (VA)
- Practice address
- 110 West Main
Suite 1
Lebanon, VA 24266 - Phone
- (276) 889-1919
- Fax
- (276) 889-4635
- NPI assigned
- Nov 1, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0202010455 | VA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Street Drug Corporation | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0202010455 | VA | Yes |
Addresses
Primary practice location
110 West Main
Suite 1
Lebanon, VA 24266
Mailing address
RR 2 Box 413
Honaker, VA 24260-9501
Phone (276) 859-2854
Other providers in Lebanon, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.