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General NPI Number Information
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NPI Number | 1477089639
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Entity Type | Organization
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Legal Business Name | CHARLOTTESVILLE FREE CLINIC
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Dates
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Enumeration Date | 05/10/2017
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Last Update Date | 03/24/2023
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Provider Practice Location Address
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Address Line | 901 PRESTON AVE, SUITE 101
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903
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Country | US
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Telephone | 434-295-8957
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Fax | 434-296-0904
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Provider Business Mailing Address
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Address Line | 901 PRESTON AVE, SUITE 101
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903
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Country | US
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Telephone | 434-295-8957
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Fax | 434-296-0904
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | MR. LAWRENCE MELVIN THOMPSON III
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Credential | CPHT
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Telephone | 434-296-5525
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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 | 0201003106
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License Number State | VA
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