Organization
EASTERN STATE HOSPITAL
Active
Other names
ESH Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK L. WOOD NHA (HOSPITAL DIRECTOR)
(757) 253-5241
Entity
Organization
Contact information
Practice address
4601 IRONBOUND RD, WILLIAMSBURG, VA 23188-2652
(757) 253-5241
(757) 253-5065
Mailing address
4601 IRONBOUND RD, WILLIAMSBURG, VA 23188-2652
(757) 253-5241
(757) 253-5065
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010230314
—
VA
01
—
004811659
MEDICARE PART D
VA
Enumeration date
09/25/2006
Last updated
11/23/2010
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