Organization
COMMUNITY PHCY OF SOUTH BOSTON,INC
Active
Other names
COMMUNITY PHCY OF SOUTH BOSTON INC
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL FISHER (OWNER)
(434) 575-7988
Entity
Organization
Contact information
Practice address
2202 BEECHMONT RD, SOUTH BOSTON, VA 24592-1614
(434) 575-7988
(434) 575-1358
Mailing address
PO BOX 506, SOUTH BOSTON, VA 24592-0506
(434) 575-7988
(434) 575-1358
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0201001935
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4809628
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
8508259
—
VA
Enumeration date
07/30/2006
Last updated
11/07/2011
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