MEDICARE: DONALD W RAWLINGS

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
2	333600000X	Pharmacy	0201000802	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4809969	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477652337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONALD W RAWLINGS

Provider Business Mailing Address
First Line	:	PO BOX 247
Second Line	:	79 COLONIAL TRAIL EAST
City	:	SURRY
State	:	VA
Zip	:	23883-0247
Country	:	US
Telephone Number	:	757-294-3607
Fax Number	:	757-294-0215

Provider Business Practice Location Address
First Line	:	79 COLONIAL TRAIL EAST
Second Line	:
City	:	SURRY
State	:	VA
Zip	:	23883-9801
Country	:	US
Telephone Number	:	757-294-3607
Fax Number	:	757-294-0215

Authorized Official
Title or Position	:	OWNER SURRY DRUG G
Name	:	DONALD WAYNE RAWLINGS
Credential	:	PHARMACIST
Telephone Number	:	757-294-3607

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	07/16/2008

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