Organization
JEFFERSON PHARMACY
Active
Other names
Jefferson Good Neighbor Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY OLIVER (PIC)
(434) 589-7902
Entity
Organization
Contact information
Practice address
194 TURKEYSAG TRL STE B, PALMYRA, VA 22963-2661
(434) 589-7902
(434) 589-7912
Mailing address
194 TURKEYSAG TRL STE B, PALMYRA, VA 22963-2661
(434) 589-7902
(434) 589-7912
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0201004268
VA
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1871731448
—
VA
01
—
2118991
PK
—
Enumeration date
02/04/2009
Last updated
04/07/2017
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