# SERVANT PHARMACY OF VIRGINIA INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Servant Pharmacy of Virginia
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629359161
- **Authorized official:** RANDY ANGEL (OWNER/COO)
- **Authorized official phone:** (919) 760-5483

## Contact information

- **Practice address:** 10370 BATTLEVIEW PKWY, MANASSAS, VA 20109-2338
- **Practice address phone:** (678) 303-1680
- **Practice address fax:** (678) 303-1686
- **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 | 0201004415 | VA | Yes |

## Other

- **Enumeration date:** 08/29/2011
- **Last updated:** 03/12/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2131606 | PK | — |