Organization
MT JACKSON DRUG STORE INC
Active
Organization
MT JACKSON DRUG STORE INC
Active
Other names
MT JACKSON DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES FANSLER (PRESIDENT OWNER)
(540) 477-3101
Entity
Organization
Contact information
Practice address
5350 MAIN ST, MOUNT JACKSON, VA 22842-9511
(540) 477-3101
(540) 477-4039
Mailing address
PO BOX 473, MOUNT JACKSON, VA 22842-0473
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0201002587
VA
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010078059
—
VA
01
—
2102235
PK
—
Enumeration date
10/20/2006
Last updated
08/16/2016
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