Healthcare Provider Details

I. General information

NPI: 1225049877
Provider Name (Legal Business Name): LAUREL FAMILY DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 S SHADY AVE
DAMASCUS VA
24236
US

IV. Provider business mailing address

PO BOX 69
DAMASCUS VA
24236-0069
US

V. Phone/Fax

Practice location:
  • Phone: 276-475-5022
  • Fax: 276-475-3614
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0201003103
License Number StateVA

VIII. Authorized Official

Name: REBECCA DEARMOND
Title or Position: OWNER
Credential: PHARM D
Phone: 276-475-5022