Provider Demographics
NPI:1053431650
Name:OWENS, ALICE A (RPH)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:A
Last Name:OWENS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 OLD KESWICK LN
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-7867
Mailing Address - Country:US
Mailing Address - Phone:804-733-7711
Mailing Address - Fax:804-733-8819
Practice Address - Street 1:1950 S SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-2729
Practice Address - Country:US
Practice Address - Phone:804-733-7711
Practice Address - Fax:804-733-8819
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202010426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist