Healthcare Provider Details

I. General information

NPI: 1255301321
Provider Name (Legal Business Name): HANCOCK LAMBERT PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 02/02/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 MAIN ST
CLINTWOOD VA
24228
US

IV. Provider business mailing address

PO BOX 1480
POUND VA
24279-1480
US

V. Phone/Fax

Practice location:
  • Phone: 276-926-6707
  • Fax: 276-926-4482
Mailing address:
  • Phone: 276-926-6707
  • Fax: 276-926-4482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0201000341
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. GREGORY BRIAN MULLINS
Title or Position: OWNER
Credential: RPH
Phone: 276-926-6707