Healthcare Provider Details

I. General information

NPI: 1477652337
Provider Name (Legal Business Name): DONALD W RAWLINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 COLONIAL TRAIL EAST
SURRY VA
23883-9801
US

IV. Provider business mailing address

PO BOX 247 79 COLONIAL TRAIL EAST
SURRY VA
23883-0247
US

V. Phone/Fax

Practice location:
  • Phone: 757-294-3607
  • Fax: 757-294-0215
Mailing address:
  • Phone: 757-294-3607
  • Fax: 757-294-0215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0201000802
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DONALD WAYNE RAWLINGS
Title or Position: OWNER SURRY DRUG G
Credential: PHARMACIST
Phone: 757-294-3607