Healthcare Provider Details

I. General information

NPI: 1326077090
Provider Name (Legal Business Name): NANTZ APOTHECARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11133 INDIAN CREEK ROAD
POUND VA
24279
US

IV. Provider business mailing address

PO BOX 1090 11133 INDIAN CREEK RD
POUND VA
24279-1090
US

V. Phone/Fax

Practice location:
  • Phone: 279-796-5500
  • Fax: 279-796-2191
Mailing address:
  • Phone: 279-796-5500
  • Fax: 279-796-2191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202205106
License Number StateVA

VIII. Authorized Official

Name: MRS. SHERRY DAWN NANTZ
Title or Position: PHARMACIST
Credential: RPH
Phone: 276-796-5500