Healthcare Provider Details

I. General information

NPI: 1619253846
Provider Name (Legal Business Name): CHS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 RIVERSIDE CIRCLE GROUND FLOOR
ROANOKE VA
24016
US

IV. Provider business mailing address

3 RIVERSIDE CIRCLE GROUND FLOOR
ROANOKE VA
24016
US

V. Phone/Fax

Practice location:
  • Phone: 540-526-1450
  • Fax: 540-985-9614
Mailing address:
  • Phone: 540-526-1450
  • Fax: 540-985-9614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0201004435
License Number StateVA

VIII. Authorized Official

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