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Organization

FORT CHISWELL PHARMACY INC

Active
Other names
Fort Chiswell Pharmacy
Organization subpart
No

Provider details

NPI number
Authorized official
STACY PETRUNYAK (PHARMACIST IN CHARGE)
(276) 637-3178
Entity
Organization

Contact information

Practice address
791 FORT CHISWELL RD, SUITE B, MAX MEADOWS, VA 24360-4139
(276) 637-3178
(276) 637-4158
Mailing address
791 FORT CHISWELL RD, SUITE B, MAX MEADOWS, VA 24360-4139
(276) 637-3178
(276) 637-4158

Taxonomy

Speciality
Code
Description
License number
State
333600000X
Pharmacy
3336C0003X
Community/Retail Pharmacy
Primary
0201002590
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2104830
PK
05
8504156
VA
Enumeration date
09/20/2006
Last updated
11/10/2016
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