Healthcare Provider Details

I. General information

NPI: 1083711824
Provider Name (Legal Business Name): STUARTS DRAFT FAMILY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 STUARTS DRAFT HWY STE 101
STUARTS DRAFT VA
24477-2753
US

IV. Provider business mailing address

PO BOX 791
STUARTS DRAFT VA
24477-0791
US

V. Phone/Fax

Practice location:
  • Phone: 540-337-3776
  • Fax: 540-337-9321
Mailing address:
  • Phone: 540-337-3776
  • Fax: 540-337-9321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0201003480
License Number StateVA

VIII. Authorized Official

Name: MARTY HUMPHREYS
Title or Position: MANAGER
Credential:
Phone: 540-337-3776