Organization
LEVISA PHARMACIES INC
Active
Other names
TRI-STATE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JOEL THORNBURY BS PHARMACY (VP)
(276) 935-7513
Entity
Organization
Contact information
Practice address
20759 RIVERSIDE DR, GRUNDY, VA 24614-6746
(276) 935-7513
(276) 935-2256
Mailing address
PO BOX 2048, GRUNDY, VA 24614-2048
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0201002326
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4820204
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
54020326
—
KY
05
—
8515514
—
VA
05
—
9137289
—
VA
Enumeration date
09/06/2006
Last updated
12/17/2010
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