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General NPI Number Information
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NPI Number | 1922187608
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Entity Type | Organization
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Legal Business Name | CENTERVILLE CARDINAL DRUG CENTER INC
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 09/12/2014
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Provider Practice Location Address
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Address Line | 46A BROAD STREET RD
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City | MANAKIN SABOT
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State | VA
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Zip | 23103-2213
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Country | US
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Telephone | 804-784-5975
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Fax | 804-784-4118
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Provider Business Mailing Address
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Address Line | 46A BROAD STREET RD
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City | MANAKIN SABOT
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State | VA
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Zip | 23103-2213
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Country | US
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Telephone | 804-784-5975
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Fax | 804-784-4118
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Authorized Official
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Title or Position | PRES PHCST
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Name | EARL GUNN
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Credential |
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Telephone | 804-784-5975
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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 |
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License Number State |
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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 | 0201002321
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License Number State | VA
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