MEDICARE: BLAIRS DRUG STORE

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	183500000X	Pharmacist	0201000045	VA

General Provider Information

NPI Number	:	1245255413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLAIRS DRUG STORE

Provider Business Mailing Address
First Line	:	3601 MECHANICSVILLE PIKE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-1329
Country	:	US
Telephone Number	:	804-329-3363
Fax Number	:	804-329-7471

Provider Business Practice Location Address
First Line	:	3601 MECHANICSVILLE PIKE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-1329
Country	:	US
Telephone Number	:	804-329-3363
Fax Number	:	804-329-7471

Authorized Official
Title or Position	:	OWNER/PRES
Name	:	IRVIN WAYNE FENTRESS
Credential	:	RPH
Telephone Number	:	804-329-3363

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	08/22/2020

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Directions to “BLAIRS DRUG STORE ” Practice Location

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