Provider Demographics
NPI:1003134420
Name:COMMONWEALTH PHARMACY CHATHAM INC
Entity Type:Organization
Organization Name:COMMONWEALTH PHARMACY CHATHAM INC
Other - Org Name:COMMONWEALTH PHARMACY CHATHAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:RODDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-432-2094
Mailing Address - Street 1:21 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:VA
Mailing Address - Zip Code:24531-5536
Mailing Address - Country:US
Mailing Address - Phone:434-432-2094
Mailing Address - Fax:434-432-2098
Practice Address - Street 1:21 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:VA
Practice Address - Zip Code:24531-5536
Practice Address - Country:US
Practice Address - Phone:434-432-2094
Practice Address - Fax:434-432-2098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BP3500X, 333600000X, 3336C0004X
VA02010043333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2125023OtherPK