Organization
TYFAN INC.
Active
Other names
WILDCAT PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY MULLINS BS - NURSING (OWNER/PHARMACIST-IN-CHARGE)
(276) 796-2200
Entity
Organization
Contact information
Practice address
11231 INDIAN CREEK ROAD, POUND, VA 24279
(276) 796-2200
(276) 796-2202
Mailing address
PO BOX 1480, POUND, VA 24279-1480
(276) 796-2200
(276) 796-2202
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0201004080
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010266238
—
VA
01
—
2105920
PK
—
05
—
7100266980
—
KY
Enumeration date
05/11/2006
Last updated
06/09/2020
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