MEDICARE: FAMILY DISCOUNT PHARMACY, INC.

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	333600000X	Pharmacy	0201003494	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4832641	OTHER	VA	NABP

General Provider Information

NPI Number	:	1174556294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY DISCOUNT PHARMACY, INC.

Provider Business Mailing Address
First Line	:	PO BOX 477
Second Line	:
City	:	STANLEYTOWN
State	:	VA
Zip	:	24168-0477
Country	:	US
Telephone Number	:	276-627-0536
Fax Number	:	276-627-6074

Provider Business Practice Location Address
First Line	:	335 RIVERSIDE DR
Second Line	:
City	:	BASSETT
State	:	VA
Zip	:	24055-4245
Country	:	US
Telephone Number	:	276-627-0536
Fax Number	:	276-627-6074

Authorized Official
Title or Position	:	PRESIDENT, HEAD PHARMACIST
Name	:	MR. JERRY RAY HARPER JR.
Credential	:	RPH.
Telephone Number	:	276-627-0536

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	10/04/2011

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