Healthcare Provider Details

I. General information

NPI: 1972582401
Provider Name (Legal Business Name): MANCHESTER HOMES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 MAIN ST
CLIFTON FORGE VA
24422-1835
US

IV. Provider business mailing address

PO BOX 637
CLIFTON FORGE VA
24422-0637
US

V. Phone/Fax

Practice location:
  • Phone: 540-862-9046
  • Fax: 540-862-0564
Mailing address:
  • Phone: 540-862-9046
  • Fax: 540-862-0564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0201003708
License Number StateVA

VIII. Authorized Official

Name: JOAN LOUISE BAY
Title or Position: PHARMACIST IN CHARGE
Credential: RPH
Phone: 540-862-9046