Healthcare Provider Details

I. General information

NPI: 1053770727
Provider Name (Legal Business Name): MAO PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2016
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 GREAT BRIDGE BLVD STE 161B
CHESAPEAKE VA
23320-3904
US

IV. Provider business mailing address

5823 PATTERSON AVE
RICHMOND VA
23226-2536
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-2247
  • Fax: 757-547-2244
Mailing address:
  • Phone: 804-288-1933
  • Fax: 804-288-1510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number0201004687
License Number StateVA

VIII. Authorized Official

Name: SHUBHRO PAL
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential:
Phone: 804-288-3620