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General NPI Number Information
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NPI Number | 1386980498
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Entity Type | Organization
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Legal Business Name | FARMVILLE PHARMACY INC
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Dates
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Enumeration Date | 12/17/2012
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Last Update Date | 12/17/2012
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Provider Practice Location Address
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Address Line | 308 S MAIN ST # A
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City | FARMVILLE
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State | VA
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Zip | 23901-1771
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Country | US
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Telephone | 703-622-0376
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Fax |
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Provider Business Mailing Address
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Address Line | 308 S MAIN ST # A
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City | FARMVILLE
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State | VA
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Zip | 23901-1771
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SCOTT K KIM
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Credential |
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Telephone | 703-622-0376
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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 | 0202209249
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License Number State | VA
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