MEDICARE: MARKET STREET PHARMACY INCORPORATED

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	332B00000X	Durable Medical Equipment & Medical Supplies
3	3336C0003X	Community/Retail Pharmacy	0201003826	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	4837324	OTHER		OTHER ID NUMBER

General Provider Information

NPI Number	:	1528173770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARKET STREET PHARMACY INCORPORATED

Provider Business Mailing Address
First Line	:	PO BOX 38
Second Line	:
City	:	NEW CASTLE
State	:	VA
Zip	:	24127-0038
Country	:	US
Telephone Number	:	540-864-8800
Fax Number	:	540-864-8803

Provider Business Practice Location Address
First Line	:	317 MARKET ST
Second Line	:
City	:	NEW CASTLE
State	:	VA
Zip	:	24127
Country	:	US
Telephone Number	:	540-864-8800
Fax Number	:	540-864-8803

Authorized Official
Title or Position	:	OWNER AND PHARMACIST
Name	:	STACEY FISHER
Credential	:	RPH
Telephone Number	:	540-864-8800

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	06/26/2014

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