Pharmacy (1580)    PERSON CLASS (8932.1)

Name Value
PROVIDER TYPE Pharmacy
CLASSIFICATION Fellow
STATUS Inactive
DATE INACTIVATED 2019-10-01 00:00:00
VA CODE V090301
X12 CODE 390200000X
INDIVIDUAL/NON INDIVIDUAL
MASTER ENTRY FOR VUID YES
VUID 5325901
EFFECTIVE DATE/TIME
  • 2018-12-13 09:56:33
    STATUS:   ACTIVE
  • 2019-10-01 08:25:04
    STATUS:   INACTIVE