Organization
NGD INCORPORATED
Active
Other names
Super Dollar Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN FIELDS (PRESIDENT)
(276) 698-1886
Entity
Organization
Contact information
Practice address
1063 EDGEWATER DR., GRUNDY, VA 24614
(276) 244-1133
(276) 244-1188
Mailing address
PO BOX 632, GRUNDY, VA 24614-0632
(276) 244-1133
(276) 244-1188
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
0201004406
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4843036
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/21/2011
Last updated
08/03/2011
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