Healthcare Provider Details

I. General information

NPI: 1497763098
Provider Name (Legal Business Name): SOUTHWESTERN VIRGINIA MENTAL HEALTH REGIONAL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 TRAINING CENTER RD
HILLSVILLE VA
24343-5149
US

IV. Provider business mailing address

PO BOX 1328
HILLSVILLE VA
24343-7328
US

V. Phone/Fax

Practice location:
  • Phone: 276-728-9081
  • Fax: 276-728-4527
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number0201003426
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number0201003426
License Number StateVA

VIII. Authorized Official

Name: MRS. PAULETTE SINNETT
Title or Position: PHARMACIST IN CHARGE
Credential: RPH
Phone: 276-728-9081