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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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