Oleg V Bandurco
Individual provider Active NPI Pharmacist · Gloucester, VA
NPI 1962002295 · NPPES record last updated Oct 27, 2020
Key facts
- NPI
- 1962002295
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 0202011950 (VA)
- Practice address
- 6819 Waltons LN
Gloucester, VA 23061-6113 - Phone
- (804) 694-0060
- Fax
- (804) 694-0500
- NPI assigned
- Oct 27, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0202011950 | VA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0202011950 | VA | Yes |
Addresses
Primary practice location
6819 Waltons LN
Gloucester, VA 23061-6113
Mailing address
6819 Waltons LN
Gloucester, VA 23061-6113
Phone (804) 694-0060
Other providers in Gloucester, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 27, 2020. 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.