Healthcare Provider Details

I. General information

NPI: 1649203746
Provider Name (Legal Business Name): GOOCHLAND PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 03/07/2023
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1956 SANDY HOOK RD.
GOOCHLAND VA
23063
US

IV. Provider business mailing address

P.O. BOX 166
GOOCHLAND VA
23063
US

V. Phone/Fax

Practice location:
  • Phone: 804-556-3607
  • Fax: 804-556-2414
Mailing address:
  • Phone: 804-556-3607
  • Fax: 804-556-2414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0201002477
License Number StateVA

VIII. Authorized Official

Name: MR. DARYL KEVIN JOHNSON II
Title or Position: OWNER/PHARMACIST IN CHARGE
Credential: PHARM D
Phone: 804-556-3607