Healthcare Provider Details

I. General information

NPI: 1669430641
Provider Name (Legal Business Name): NTA, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18014 JEFFERSON DAVIS HWY
RUTHER GLEN VA
22546-2922
US

IV. Provider business mailing address

PO BOX 10
LADYSMITH VA
22501-0010
US

V. Phone/Fax

Practice location:
  • Phone: 804-448-2606
  • Fax: 804-448-0159
Mailing address:
  • Phone: 804-448-2606
  • Fax: 804-448-0159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0201001307
License Number StateVA

VIII. Authorized Official

Name: MR. WILLIAM WALDEN ABERNATHY
Title or Position: PRESIDENT/PHARMACIST-IN-CHARGE
Credential: RPH
Phone: 804-448-2606