Healthcare Provider Details

I. General information

NPI: 1821456484
Provider Name (Legal Business Name): SHORT PUMP PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11934 W BROAD ST
RICHMOND VA
23233-1007
US

IV. Provider business mailing address

12230 IRON BRIDGE RD SUITE C
CHESTER VA
23831-1534
US

V. Phone/Fax

Practice location:
  • Phone: 804-717-5000
  • Fax: 804-717-8300
Mailing address:
  • Phone: 804-717-5000
  • Fax: 804-717-8300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHRIS CURRIN
Title or Position: OWNER/PHARMACIST
Credential:
Phone: 804-717-5000