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Organization
EASTERN STATE HOSPITAL
Active
Organization
EASTERN STATE HOSPITAL
Active
Other names
ESH Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK L. WOOD NHA (HOSPITAL DIRECTOR)
(757) 253-5241
Entity
Organization
Contact information
Practice address
4601 IRONBOUND RD, WILLIAMSBURG, VA 23188-2652
(757) 253-5241
(757) 253-5065
Mailing address
4601 IRONBOUND RD, WILLIAMSBURG, VA 23188-2652
(757) 253-5241
(757) 253-5065
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010230314
—
VA
01
—
004811659
MEDICARE PART D
VA
Enumeration date
09/25/2006
Last updated
11/23/2010
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