Organization
FORT CHISWELL PHARMACY INC
Active
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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