MEDICARE: TOM LAMARTINA INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	0201000073	VA
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4805151	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1174610083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOM LAMARTINA INC

Provider Business Mailing Address
First Line	:	PO BOX 66
Second Line	:
City	:	BROOKNEAL
State	:	VA
Zip	:	24528-0066
Country	:	US
Telephone Number	:	434-376-2220
Fax Number	:	434-376-2220

Provider Business Practice Location Address
First Line	:	120 RUSH ST W
Second Line	:
City	:	BROOKNEAL
State	:	VA
Zip	:	24528-3026
Country	:	US
Telephone Number	:	434-376-2220
Fax Number	:	434-376-2220

Authorized Official
Title or Position	:	PIC/OWNER
Name	:	DR. NATHAN PAYNE
Credential	:	PHARMD
Telephone Number	:	434-376-2220

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	01/21/2021

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Directions to “TOM LAMARTINA INC ” Practice Location

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