Organization
BURNT CHIMNEY PHARMACY INC.
Active
Other names
Super-D Drug Store
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GERALD BRUCE THOMPSON (GENERAL MANAGER)
(540) 345-8342
Entity
Organization
Contact information
Practice address
414 9TH ST SE, ROANOKE, VA 24013-1506
(540) 345-8342
(540) 345-8237
Mailing address
414 9TH ST SE, ROANOKE, VA 24013-1506
(540) 345-8342
(540) 345-8237
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0201003224
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8514020
—
VA
Enumeration date
07/25/2006
Last updated
08/22/2020
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