MEDICARE: COMMONWEALTH 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	332B00000X	Durable Medical Equipment & Medical Supplies	0201002863	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

General Provider Information

NPI Number	:	1336147909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMONWEALTH PHARMACY

Provider Business Mailing Address
First Line	:	949 PINEY FOREST RD
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24540-1549
Country	:	US
Telephone Number	:	434-836-7146
Fax Number	:	434-835-0031

Provider Business Practice Location Address
First Line	:	949 PINEY FOREST RD
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24540-1549
Country	:	US
Telephone Number	:	434-836-7146
Fax Number	:	434-835-0031

Authorized Official
Title or Position	:	INS SECRETARY
Name	:	MRS. BARBARA M GROGAN
Credential	:
Telephone Number	:	434-836-7146

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	04/15/2010

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Directions to “COMMONWEALTH PHARMACY ” Practice Location

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