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General NPI Number Information
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NPI Number | 1902157712
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Entity Type | Organization
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Legal Business Name | BRADLEY FREE CLINIC OF ROANOKE VALLEY
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Dates
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Enumeration Date | 09/20/2012
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 1240 3RD ST SW
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City | ROANOKE
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State | VA
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Zip | 24016-4612
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Country | US
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Telephone | 540-344-5156
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Fax | 540-777-0726
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Provider Business Mailing Address
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Address Line | 1240 3RD ST SW
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City | ROANOKE
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State | VA
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Zip | 24016-4612
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Country | US
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Telephone | 540-344-5156
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Fax | 540-777-0726
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | JAMES BLACK
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Credential |
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Telephone | 540-344-5156
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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 | 0201002648
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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