Healthcare Provider Details

I. General information

NPI: 1083790901
Provider Name (Legal Business Name): CHESAPEAKE PHARMACY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 HARRIS RD
KILMARNOCK VA
22482
US

IV. Provider business mailing address

PO BOX 1449
KILMARNOCK VA
22482-1449
US

V. Phone/Fax

Practice location:
  • Phone: 804-435-6473
  • Fax: 804-435-8667
Mailing address:
  • Phone: 804-435-8582
  • Fax: 804-435-8543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0201003760
License Number StateVA

VIII. Authorized Official

Name: MR. BERNARD P LOCKSTAMPFOR JR.
Title or Position: TREASURER
Credential:
Phone: 804-435-8582