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General NPI Number Information
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NPI Number | 1952788135
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Entity Type | Organization
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Legal Business Name | MAO PHARMACY, INC.
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Dates
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Enumeration Date | 04/27/2015
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Last Update Date | 04/27/2015
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Provider Practice Location Address
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Address Line | 107 S 5TH ST 1ST FLOOR, ROOM 178
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City | RICHMOND
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State | VA
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Zip | 23219-3825
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Country | US
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Telephone | 804-716-7149
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Fax | 804-716-7076
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Provider Business Mailing Address
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Address Line | 107 S 5TH ST 1ST FLOOR, ROOM 178
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City | RICHMOND
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State | VA
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Zip | 23219-3825
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Country | US
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Telephone | 804-716-7149
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Fax | 804-716-7076
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Authorized Official
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Title or Position | VICE PRESIDENT OF CLINICAL SERVICES
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Name | DR. SHANNON DOWDY
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Credential | PHARMD
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Telephone | 804-288-1933
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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 | 0201004641
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 0201004641
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License Number State | VA
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