Healthcare Provider Details

I. General information

NPI: 1710084553
Provider Name (Legal Business Name): BLAND COUNTY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12315 GRAPEFIELD RD
BASTIAN VA
24314-4547
US

IV. Provider business mailing address

12315 GRAPEFIELD RD
BASTIAN VA
24314-4547
US

V. Phone/Fax

Practice location:
  • Phone: 276-688-4204
  • Fax: 276-688-2450
Mailing address:
  • Phone: 276-688-4204
  • Fax: 276-688-2450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0201001869
License Number StateVA

VIII. Authorized Official

Name: CHERYL KEGLEY
Title or Position: PIC
Credential:
Phone: 276-688-4204