1184714230 NPI number — RUSSELL FORK PHARMACIES, INC.

Table of content: (NPI 1184714230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184714230 NPI number — RUSSELL FORK PHARMACIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUSSELL FORK PHARMACIES, 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:
JONES & COUNTS 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:
1184714230
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 99
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAYSI
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24256-0099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-865-5560
Provider Business Mailing Address Fax Number:
276-865-5310

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
251 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAYSI
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-865-5560
Provider Business Practice Location Address Fax Number:
276-865-5310
Provider Enumeration Date:
10/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COUNTS
Authorized Official First Name:
ERVIN
Authorized Official Middle Name:
GREY
Authorized Official Title or Position:
PHARMACIST-IN-CHARGE
Authorized Official Telephone Number:
276-865-5560

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  0201003911 , 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)

  • Identifier: 4837463 . This is a "NCPDP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 008520020 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".