Healthcare Provider Details

I. General information

NPI: 1003134420
Provider Name (Legal Business Name): COMMONWEALTH PHARMACY CHATHAM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2010
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 S MAIN ST
CHATHAM VA
24531-5536
US

IV. Provider business mailing address

21 S MAIN ST
CHATHAM VA
24531-5536
US

V. Phone/Fax

Practice location:
  • Phone: 434-432-2094
  • Fax: 434-432-2098
Mailing address:
  • Phone: 434-432-2094
  • Fax: 434-432-2098

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 Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0201004333
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DONALD RODDEN
Title or Position: PHARMACIST/OWNER
Credential:
Phone: 434-432-2094