1154608685 NPI number — AUGUSTA FAMILY PHARMACY INC.

Table of content: (NPI 1154608685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154608685 NPI number — AUGUSTA FAMILY PHARMACY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUGUSTA FAMILY PHARMACY INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FISHERSVILLE FAMILY PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154608685
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1782 JEFFERSON HWY
Provider Second Line Business Mailing Address:
UNIT G
Provider Business Mailing Address City Name:
FISHERSVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22939-2276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-324-8042
Provider Business Mailing Address Fax Number:
540-949-4478

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1782 JEFFERSON HWY
Provider Second Line Business Practice Location Address:
UNIT G
Provider Business Practice Location Address City Name:
FISHERSVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22939-2276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-324-8042
Provider Business Practice Location Address Fax Number:
540-949-4478
Provider Enumeration Date:
11/11/2011

Additional Information

Authorized Official

Authorized Official Last Name:
YEAGER
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
540-836-9456

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  0201004438 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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