Healthcare Provider Details

I. General information

NPI: 1013090133
Provider Name (Legal Business Name): GUND PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S THIRD STREET
SHENANDOAH VA
22849
US

IV. Provider business mailing address

420 S THIRD STREET
SHENANDOAH VA
22849
US

V. Phone/Fax

Practice location:
  • Phone: 540-652-8619
  • Fax: 540-652-4401
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0201002475
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL GUND
Title or Position: OWNER PIC
Credential: RPH
Phone: 540-652-8619