Healthcare Provider Details

I. General information

NPI: 1073104543
Provider Name (Legal Business Name): ERVIN COUNTS PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 06/28/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 HAYSI MAIN STREET
HAYSI VA
24256
US

IV. Provider business mailing address

PO BOX 147
BIRCHLEAF VA
24220-0147
US

V. Phone/Fax

Practice location:
  • Phone: 276-865-5560
  • Fax: 276-865-5310
Mailing address:
  • Phone: 276-865-0204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202010366
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: