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General NPI Number Information
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NPI Number | 1336118033
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Entity Type | Organization
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Legal Business Name | ULTRAPHARM,INC T/A WONDER DRUG SOUTHEAST PHARMACY
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Dates
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Enumeration Date | 03/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1224A JAMISON AVE
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City | ROANOKE
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State | VA
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Zip | 24013-1909
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Country | US
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Telephone | 540-393-9306
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Fax | 540-393-9307
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Provider Business Mailing Address
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Address Line | 1224A JAMISON AVE SE
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City | ROANOKE
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State | VA
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Zip | 24013-1909
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Country | US
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Telephone | 540-393-9306
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Fax | 540-393-9307
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Authorized Official
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Title or Position | OWNER/PRES
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Name | MRS. PATRICIA A CHOPSKI
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Credential |
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Telephone | 540-343-9306
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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 | 0201002967
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License Number State | VA
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