Healthcare Provider Details

I. General information

NPI: 1780776203
Provider Name (Legal Business Name): RX VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19771 MAIN ST
BUCHANAN VA
24066-5500
US

IV. Provider business mailing address

19771 MAIN ST
BUCHANAN VA
24066-5500
US

V. Phone/Fax

Practice location:
  • Phone: 540-254-2904
  • Fax: 540-254-2907
Mailing address:
  • Phone: 540-254-2904
  • Fax: 540-254-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0201004066
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBERT LADD
Title or Position: OWNER/PHARMACIST
Credential:
Phone: 540-254-2904