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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