MEDICARE: HARNESS HEALTH PHARMACY - VIRGINIA LLC

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
2	3336C0003X	Community/Retail Pharmacy	0201004667	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2153965	OTHER		PK

General Provider Information

NPI Number	:	1205204286
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARNESS HEALTH PHARMACY - VIRGINIA LLC

Provider Business Mailing Address
First Line	:	8200 MEADOWBRIDGE RD STE 301
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-2337
Country	:	US
Telephone Number	:	804-442-3754
Fax Number	:	804-569-6034

Provider Business Practice Location Address
First Line	:	8200 MEADOWBRIDGE RD STE 301
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116
Country	:	US
Telephone Number	:	804-442-3754
Fax Number	:	804-569-6034

Authorized Official
Title or Position	:	VP REIMBURSEMENT
Name	:	KIMBERLY M RALSTON
Credential	:
Telephone Number	:	419-996-5119

Provider Enumeration Date	:	09/09/2015
Last Update Date	:	12/09/2025

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Directions to “HARNESS HEALTH PHARMACY - VIRGINIA LLC ” Practice Location

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