=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841236338
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOAD & DAVIS COMPANY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2006
-----------------------------------------------------
Last Update Date | 01/22/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1312 MEMORIAL BLVD S
-----------------------------------------------------
City | MARTINSVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24112-4809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-632-6222
-----------------------------------------------------
Fax | 276-632-3294
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1312 MEMORIAL BLVD S
-----------------------------------------------------
City | MARTINSVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24112-4809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-632-6222
-----------------------------------------------------
Fax | 276-632-3294
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PIC
-----------------------------------------------------
Name | PAMELA FULLER MILLER
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 276-632-6222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 0201000774
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------