| Name | Value |
|---|---|
| PROVIDER TYPE | Pharmacy Service Providers |
| CLASSIFICATION | Pharmacist |
| DEFINITION | A licensed pharmacist who has demonstrated specialized knowledge and skill in maintenance and/or restoration of optimal nutritional status, designing and modifying treatment according to patient needs. |
| AREA OF SPECIALIZATION | Nutrition Support |
| STATUS | Active |
| VA CODE | V090103 |
| X12 CODE | 1835N1003X |
| SPECIALTY CODE | 87 |
| INDIVIDUAL/NON | INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5253293 |
| EFFECTIVE DATE/TIME |
|