Healthcare Provider Details

I. General information

NPI: 1659821361
Provider Name (Legal Business Name): J W PLATT, RPH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2016
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2228 PAPERMILL RD SUITE E
WINCHESTER VA
22601-3681
US

IV. Provider business mailing address

443 CANYON RD
WINCHESTER VA
22602-7048
US

V. Phone/Fax

Practice location:
  • Phone: 540-723-6883
  • Fax: 540-723-9704
Mailing address:
  • Phone: 540-723-6883
  • Fax: 540-723-9704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0202006257
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number0202006257
License Number StateVA

VIII. Authorized Official

Name: MR. JOHN WING PLATT
Title or Position: OWNER
Credential: BSPHARM
Phone: 540-723-6883