Organization
FIFTH SANITARY FOOD STORE INC
Active
Other names
MARSHALL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
HOLDER TRUMBO (VICE PRESIDENT)
(540) 364-9568
Entity
Organization
Contact information
Practice address
8382 WEST MAIN STREET, MARSHALL, VA 20115
(540) 364-9568
(540) 364-1479
Mailing address
PO BOX 496, MARSHALL, VA 20116-0496
(540) 364-9568
(540) 364-1479
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0201001805
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00851315
—
VA
01
—
4816801
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/02/2007
Last updated
02/28/2012
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