Healthcare Provider Details

I. General information

NPI: 1710920020
Provider Name (Legal Business Name): RAYFIELD'S PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9502 HOSPITAL AVE
NASSAWADOX VA
23413
US

IV. Provider business mailing address

PO BOX 213
NASSAWADOX VA
23413-0213
US

V. Phone/Fax

Practice location:
  • Phone: 757-442-6159
  • Fax: 757-442-2434
Mailing address:
  • Phone: 757-442-6159
  • Fax: 757-442-2434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0201001932
License Number StateVA

VIII. Authorized Official

Name: THOMAS RAYFIELD
Title or Position: OWNER,RPH,AO
Credential: RPH
Phone: 757-442-6159