Healthcare Provider Details

I. General information

NPI: 1336147909
Provider Name (Legal Business Name): COMMONWEALTH PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 04/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 PINEY FOREST RD
DANVILLE VA
24540-1549
US

IV. Provider business mailing address

949 PINEY FOREST RD
DANVILLE VA
24540-1549
US

V. Phone/Fax

Practice location:
  • Phone: 434-836-7146
  • Fax: 434-835-0031
Mailing address:
  • Phone: 434-836-7146
  • Fax: 434-835-0031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0201002863
License Number StateVA

VIII. Authorized Official

Name: MRS. BARBARA M GROGAN
Title or Position: INS SECRETARY
Credential:
Phone: 434-836-7146