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General NPI Number Information
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NPI Number | 1053770727
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Entity Type | Organization
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Legal Business Name | MAO PHARMACY INC.
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Dates
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Enumeration Date | 02/23/2016
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Last Update Date | 02/23/2016
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Provider Practice Location Address
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Address Line | 224 GREAT BRIDGE BLVD STE 161B
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City | CHESAPEAKE
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State | VA
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Zip | 23320-3904
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Country | US
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Telephone | 757-547-2247
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Fax | 757-547-2244
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Provider Business Mailing Address
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Address Line | 5823 PATTERSON AVE
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City | RICHMOND
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State | VA
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Zip | 23226-2536
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Country | US
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Telephone | 804-288-1933
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Fax | 804-288-1510
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Authorized Official
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Title or Position | VICE PRESIDENT OF OPERATIONS
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Name | SHUBHRO PAL
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Credential |
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Telephone | 804-288-3620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 0201004687
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License Number State | VA
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