Organization
BLUE RIDGE APOTHECARY INC
Active
Other names
Blue Ridge Apothecary
Organization subpart
No
Provider details
NPI number
Authorized official
GRAHAM STEPHENS (OWNER/CEO)
(540) 345-6480
Entity
Organization
Contact information
Practice address
2122 COLONIAL AVE SW, ROANOKE, VA 24015-3205
(540) 345-6480
(540) 345-6844
Mailing address
2122 COLONIAL AVE SW, ROANOKE, VA 24015-3205
(540) 345-6480
(540) 345-6844
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
020100003731
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2160413
PK
—
Enumeration date
04/24/2014
Last updated
02/22/2017
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