Healthcare Provider Details

I. General information

NPI: 1215049127
Provider Name (Legal Business Name): UNCHAINED RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2263 MAGNOLIA AVE
BUENA VISTA VA
24416-3121
US

IV. Provider business mailing address

2263 MAGNOLIA AVE
BUENA VISTA VA
24416-3121
US

V. Phone/Fax

Practice location:
  • Phone: 540-261-2896
  • Fax: 540-261-1635
Mailing address:
  • Phone: 540-261-2896
  • Fax: 540-261-1635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0201003441
License Number StateVA

VIII. Authorized Official

Name: BRIAN MORRIS
Title or Position: PRESIDENT
Credential:
Phone: 540-261-2896