MEDICARE: CLARKSVILLE COMMUNITY 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	183500000X	Pharmacist	0201003454	VA

General Provider Information

NPI Number	:	1255350807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARKSVILLE COMMUNITY PHARMACY, INC.

Provider Business Mailing Address
First Line	:	11226 HWY. 15 S.
Second Line	:	PO BOX 1794
City	:	CLARKSVILLE
State	:	VA
Zip	:	23927
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11226 HWY. 15 S.
Second Line	:
City	:	CLARKSVILLE
State	:	VA
Zip	:	23927
Country	:	US
Telephone Number	:	434-374-2623
Fax Number	:	434-374-2624

Authorized Official
Title or Position	:	PHARMACIST-OWNER
Name	:	KEVIN ALLGOOD
Credential	:
Telephone Number	:	434-374-2623

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	08/22/2020

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