Healthcare Provider Details

I. General information

NPI: 1669409801
Provider Name (Legal Business Name): PRINCE GEORGE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5720 COURTHOUSE RD
PRINCE GEORGE VA
23875-3215
US

IV. Provider business mailing address

5720 COURTHOUSE RD
PRINCE GEORGE VA
23875-3215
US

V. Phone/Fax

Practice location:
  • Phone: 804-861-3400
  • Fax: 804-861-2617
Mailing address:
  • Phone: 804-861-3400
  • Fax: 804-861-2617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0201001872
License Number StateVA

VIII. Authorized Official

Name: MR. BRIAN COEY
Title or Position: OWNER
Credential:
Phone: 804-861-3400