# SERVANT PHARMACY OF VIRGINIA INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SERVANT PHARMACY OF VIRGINIA LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588675078
- **Authorized official:** RANDALL ANGEL PHRMD (COO TREASURER)
- **Authorized official phone:** (919) 760-5483

## Contact information

- **Practice address:** 90 TOWN CENTER ST STE 204, DALEVILLE, VA 24083-3742
- **Practice address phone:** (540) 777-1505
- **Practice address fax:** (540) 777-1507
- **Mailing address:** 2451 CUMBERLAND PKWY SE, SUITE 3694, ATLANTA, GA 30339-6136
- **Mailing address phone:** (678) 303-1680
- **Mailing address fax:** (678) 303-1686

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | 0201003972 | VA | Yes |

## Other

- **Enumeration date:** 08/10/2006
- **Last updated:** 03/06/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4838112 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |
| 05 | — | 8512655 | — | VA |