Healthcare Provider Details

I. General information

NPI: 1588110258
Provider Name (Legal Business Name): CHS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 CRYSTAL SPRING AVE SW STE 110
ROANOKE VA
24014-2462
US

IV. Provider business mailing address

2001 CRYSTAL SPRING AVE SW STE 110
ROANOKE VA
24014-2462
US

V. Phone/Fax

Practice location:
  • Phone: 540-266-6191
  • Fax: 540-853-0910
Mailing address:
  • Phone: 540-266-6191
  • Fax: 540-853-0910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number0201002117
License Number StateVA

VIII. Authorized Official

Name: ADRIAN WILSON
Title or Position: DIRECTOR OF RETAIL PHARMACY
Credential: PHARMD
Phone: 540-266-6191