1073855094 NPI number — BATTLETOWN PHARMACY, INC.

Table of content: (NPI 1073855094)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073855094 NPI number — BATTLETOWN PHARMACY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BATTLETOWN 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:
BATTLETOWN 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:
1073855094
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 W MAIN ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
BERRYVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22611-1340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-955-0500
Provider Business Mailing Address Fax Number:
540-955-0515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 W MAIN ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BERRYVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22611-1340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-955-0500
Provider Business Practice Location Address Fax Number:
540-955-0515
Provider Enumeration Date:
03/18/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
LOUISE
Authorized Official Title or Position:
PRESIDENT/PHARMACIST-IN-CHARGE
Authorized Official Telephone Number:
540-686-5485

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  0201004539 , 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: 1073855094 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6939960001 . This is a "MEDICARE PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".