Healthcare Provider Details

I. General information

NPI: 1457631079
Provider Name (Legal Business Name): PCMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9555 KINGS CHARTER DR SUITE D
ASHLAND VA
23005-7994
US

IV. Provider business mailing address

9962 BROOK RD #601
GLEN ALLEN VA
23059-6501
US

V. Phone/Fax

Practice location:
  • Phone: 888-513-5444
  • Fax: 804-550-5173
Mailing address:
  • Phone: 888-513-5444
  • Fax: 804-550-5173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0201004065
License Number StateVA

VIII. Authorized Official

Name: RODNEY LEONARD BURTON
Title or Position: PHARMACIST-IN-CHARGE
Credential:
Phone: 888-513-5444