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General NPI Number Information
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NPI Number | 1942267497
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Entity Type | Organization
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Legal Business Name | MODERN PHARMACY INC
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 11/21/2014
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Provider Practice Location Address
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Address Line | 155 S MAIN ST
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City | DANVILLE
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State | VA
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Zip | 24541-2921
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Country | US
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Telephone | 434-793-5711
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Fax | 434-792-2516
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Provider Business Mailing Address
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Address Line | 155 S MAIN ST
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City | DANVILLE
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State | VA
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Zip | 24541-2921
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Country | US
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Telephone | 434-793-5711
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Fax | 434-792-2516
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Authorized Official
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Title or Position | OWNER
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Name | GLENN MILAM
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Credential | PHARM D
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Telephone | 434-793-5711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 0201000491
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License Number State | VA
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