Organization
POWHATAN PHARMACY INC
Active
Organization
POWHATAN PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GINA THOMPSON (PHARMACY DIRECTOR)
(804) 379-6986
Entity
Organization
Contact information
Practice address
1799 SOUTHCREEK ONE, STE A, POWHATAN, VA 23139-7960
(804) 379-6986
(804) 379-1086
Mailing address
1799 SOUTHCREEK ONE, STE L, POWHATAN, VA 23139-7960
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
0201001368
VA
3336C0003X
Community/Retail Pharmacy
Primary
0201001368
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00022F
MEDICARE FLU
VA
05
—
008510644
—
VA
05
—
009138854
—
VA
01
—
4808361
NABP
VA
01
—
P00231424
MEDICARE RAILROAD
VA
Enumeration date
06/15/2005
Last updated
06/01/2015
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