Healthcare Provider Details

I. General information

NPI: 1831282946
Provider Name (Legal Business Name): FOOD LION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 VIRGINIA AVE
CLARKSVILLE VA
23927
US

IV. Provider business mailing address

PO BOX 1000 MS 3000
PORTLAND ME
04104-5005
US

V. Phone/Fax

Practice location:
  • Phone: 434-374-5620
  • Fax: 434-374-5787
Mailing address:
  • Phone: 207-885-7454
  • Fax: 207-885-3121

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 TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARGARET M HAM
Title or Position: PRESIDENT
Credential:
Phone: 207-885-7454