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General NPI Number Information
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NPI Number | 1063877041
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Entity Type | Organization
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Legal Business Name | SEARS HOLDINGS COMPANY
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Dates
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Enumeration Date | 12/17/2015
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Last Update Date | 12/17/2015
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Provider Practice Location Address
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Address Line | 2315 WARDS RD
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City | LYNCHBURG
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State | VA
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Zip | 24502-2101
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Country | US
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Telephone | 434-239-0387
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Fax | 847-396-2803
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Provider Business Mailing Address
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Address Line | 2315 WARDS RD
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City | LYNCHBURG
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State | VA
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Zip | 24502-2101
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Country | US
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Telephone | 434-239-0387
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Fax | 847-396-2803
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Authorized Official
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Title or Position | PHARMACIST
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Name | DANIEL LINEBERRY II
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Credential | PHARMD
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Telephone | 434-239-0387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 0202206233
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License Number State | VA
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