Organization
BROADWATER DRUG, INC
Active
Other names
Broadwater Drug
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY RAY STREET RPH (OWNER-PHARMACIST)
(276) 386-3821
Entity
Organization
Contact information
Practice address
166 E JACKSON ST, GATE CITY, VA 24251-3417
(276) 386-3821
(276) 386-7582
Mailing address
166 E JACKSON ST, GATE CITY, VA 24251-3417
(276) 386-3821
(276) 386-7582
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
0201000069
VA
Other
Enumeration date
07/15/2006
Last updated
08/22/2020
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