Healthcare Provider Details

I. General information

NPI: 1104880582
Provider Name (Legal Business Name): BOYDTON COMMUNITY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 WASHINGTON ST
BOYDTON VA
23917
US

IV. Provider business mailing address

390 WASHINGTON ST
BOYDTON VA
23917
US

V. Phone/Fax

Practice location:
  • Phone: 434-738-6102
  • Fax: 434-738-6982
Mailing address:
  • Phone: 434-738-6102
  • Fax: 434-738-6982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: CAROL DILL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 434-738-6102