Healthcare Provider Details

I. General information

NPI: 1154146389
Provider Name (Legal Business Name): COMMONSHARE IMPERIAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 BELLEVUE AVE # 11
RICHMOND VA
23227-3961
US

IV. Provider business mailing address

1602 SKIPWITH RD STE 201
HENRICO VA
23229-5205
US

V. Phone/Fax

Practice location:
  • Phone: 804-688-1777
  • Fax: 804-410-1035
Mailing address:
  • Phone: 804-416-6255
  • Fax: 804-967-3999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM MILTON WEIMER II
Title or Position: MANAGING MEMBER
Credential:
Phone: 804-424-0551