| Name | Value |
|---|---|
| PROVIDER TYPE | Pharmacy Service Providers |
| CLASSIFICATION | Pharmacist |
| DEFINITION | A licensed pharmacist who has demonstrated specialized knowledge and skill in the delivery of patient care services by pharmacists that ensures the safe and effective use of medications for all children from neonates through adolescents. |
| AREA OF SPECIALIZATION | Pediatrics |
| STATUS | Active |
| VA CODE | V090111 |
| X12 CODE | 1835P0200X |
| SPECIALTY CODE | A5 |
| INDIVIDUAL/NON | INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5253299 |
| EFFECTIVE DATE/TIME |
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