Organization
SERVANT PHARMACY OF VIRGINIA INC
Active
Other names
SERVANT PHARMACY OF VIRGINIA LLC
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL ANGEL PHRMD (COO TREASURER)
(919) 760-5483
Entity
Organization
Contact information
Practice address
90 TOWN CENTER ST STE 204, DALEVILLE, VA 24083-3742
(540) 777-1505
(540) 777-1507
Mailing address
2451 CUMBERLAND PKWY SE, SUITE 3694, ATLANTA, GA 30339-6136
(678) 303-1680
(678) 303-1686
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
0201003972
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4838112
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
8512655
—
VA
Enumeration date
08/10/2006
Last updated
03/06/2013
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