Healthcare Provider Details

I. General information

NPI: 1003911884
Provider Name (Legal Business Name): CLAYPOOL HILL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12252 GOVENOR GEORGE C PEERY HWY
POUNDING MILL VA
24637
US

IV. Provider business mailing address

PO BOX 690
POUNDING MILL VA
24637-0690
US

V. Phone/Fax

Practice location:
  • Phone: 276-963-3502
  • Fax: 276-963-3757
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0201004017
License Number StateVA

VIII. Authorized Official

Name: SHANNON MCGRAW
Title or Position: OWNER
Credential: PHARM D
Phone: 276-963-3502