MEDICARE: MODERN PHARMACY 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	3336C0003X	Community/Retail Pharmacy	0201000491	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2102444	OTHER	PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942267497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MODERN PHARMACY INC

Provider Business Mailing Address
First Line	:	155 S MAIN ST
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24541-2921
Country	:	US
Telephone Number	:	434-793-5711
Fax Number	:	434-792-2516

Provider Business Practice Location Address
First Line	:	155 S MAIN ST
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24541-2921
Country	:	US
Telephone Number	:	434-793-5711
Fax Number	:	434-792-2516

Authorized Official
Title or Position	:	OWNER
Name	:	GLENN MILAM
Credential	:	PHARM D
Telephone Number	:	434-793-5711

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	11/21/2014

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Directions to “MODERN PHARMACY INC ” Practice Location

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