Healthcare Provider Details

I. General information

NPI: 1932141231
Provider Name (Legal Business Name): PCH INVESTORS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18688 JEB STUART HWY
STUART VA
24171-1559
US

IV. Provider business mailing address

18688 JEB STUART HWY
STUART VA
24171-1559
US

V. Phone/Fax

Practice location:
  • Phone: 276-694-8627
  • Fax: 276-694-8626
Mailing address:
  • Phone: 276-694-8627
  • Fax: 276-694-8626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number0201001168
License Number StateVA

VIII. Authorized Official

Name: JANICE WILKINS
Title or Position: ADMINISTRATION
Credential:
Phone: 276-694-8678