Organization
KMART 4062
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANNY EDWARD STEVENS (PHARMACY MANAGER)
(434) 799-0162
Entity
Organization
Contact information
Practice address
3311 RIVERSIDE DR, DANVILLE, VA 24541-3430
(434) 799-0162
(847) 396-2798
Mailing address
3710 TOM FORK RD, RINGGOLD, VA 24586-3844
(434) 822-5873
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
0202010116
VA
Other
Enumeration date
03/29/2016
Last updated
03/29/2016
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