Healthcare Provider Details

I. General information

NPI: 1851332662
Provider Name (Legal Business Name): RIDGEWAY FAMILY PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6581 GREENSBORO RD
RIDGEWAY VA
24148-3278
US

IV. Provider business mailing address

PO BOX 4589
MARTINSVILLE VA
24115-4589
US

V. Phone/Fax

Practice location:
  • Phone: 276-956-5520
  • Fax: 276-956-3174
Mailing address:
  • Phone: 276-956-5520
  • Fax: 276-956-3174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0201-004089
License Number StateVA

VIII. Authorized Official

Name: MR. ROBERT ANTHONY PRATT
Title or Position: PRESIDENT
Credential:
Phone: 276-634-0922