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General NPI Number Information
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NPI Number | 1174620918
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Entity Type | Organization
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Legal Business Name | OLDE VIRGINIA PHARMACY, INC.
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 1592 FINCASTLE TPKE
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City | TAZEWELL
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State | VA
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Zip | 24651-6167
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Country | US
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Telephone | 276-988-7977
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Fax | 276-988-7469
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Provider Business Mailing Address
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Address Line | PO BOX 664
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City | TAZEWELL
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State | VA
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Zip | 24651-0664
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Country | US
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Telephone | 276-988-7977
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Fax | 276-988-1098
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Authorized Official
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Title or Position | PHARMACIST/OWNER/PRESIDENT
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Name | SCOTT COLE
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Credential | PHARMD
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Telephone | 276-988-7977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 0201003318
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License Number State | VA
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