MEDICARE: TEMPLE AVE PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1043789449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEMPLE AVE PHARMACY

Provider Business Mailing Address
First Line	:	2000 SNEAD AVE
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2428
Country	:	US
Telephone Number	:	804-526-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 SNEAD AVE
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2428
Country	:	US
Telephone Number	:	804-526-1000
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	SCOTT KIM
Credential	:
Telephone Number	:	804-526-1000

Provider Enumeration Date	:	11/15/2018
Last Update Date	:	11/15/2018

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