MEDICARE: HARNESS HEALTH PHARMACY - VIRGINIA LLC

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
2	3336C0003X	Community/Retail Pharmacy	0201004574	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2145445	OTHER		PK

General Provider Information

NPI Number	:	1750701066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARNESS HEALTH PHARMACY - VIRGINIA LLC

Provider Business Mailing Address
First Line	:	1510 N 28TH ST STE 100
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-5311
Country	:	US
Telephone Number	:	804-325-8795
Fax Number	:

Provider Business Practice Location Address
First Line	:	1510 N 28TH ST STE 100
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-5311
Country	:	US
Telephone Number	:	804-325-8795
Fax Number	:

Authorized Official
Title or Position	:	VP REIMBURSEMENT
Name	:	KIMBERLY M RALSTON
Credential	:
Telephone Number	:	419-996-5119

Provider Enumeration Date	:	04/25/2014
Last Update Date	:	12/09/2025

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