1336147909 NPI number — COMMONWEALTH PHARMACY

Table of content: MRS. KATHERINE RUTH BLUM M.A. (NPI 1336486059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336147909 NPI number — COMMONWEALTH PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMONWEALTH PHARMACY
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:
Provider Other Organization Name Type Code:
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:
1336147909
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
949 PINEY FOREST RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24540-1549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-836-7146
Provider Business Mailing Address Fax Number:
434-835-0031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
949 PINEY FOREST RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24540-1549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-836-7146
Provider Business Practice Location Address Fax Number:
434-835-0031
Provider Enumeration Date:
07/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GROGAN
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
INS SECRETARY
Authorized Official Telephone Number:
434-836-7146

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0201002863 , 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: 009141782 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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