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General NPI Number Information
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NPI Number | 1598733768
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Entity Type | Organization
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Legal Business Name | COMMUNITY RESOURCE PHARMACY
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 26317 WEST WASHINGTON STREET, EXTENDED BUILDING #110
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City | PETERSBURG
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State | VA
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Zip | 23803
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Country | US
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Telephone | 804-524-7657
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Fax | 804-524-7079
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Provider Business Mailing Address
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Address Line | PO BOX 4030
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City | PETERSBURG
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State | VA
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Zip | 23803-0030
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Country | US
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Telephone | 804-524-7657
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Fax | 804-524-7079
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Authorized Official
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Title or Position | PHARMACIST-IN-CHARGE
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Name | MR. JOHN E. WALL
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Credential | R.PH.
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Telephone | 804-524-7657
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 0201004069
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License Number State | VA
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