Provider Demographics
NPI:1003900317
Name:DAVID W GARBER
Entity Type:Organization
Organization Name:DAVID W GARBER
Other - Org Name:FISHBURNE & SON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GARBER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:540-949-8211
Mailing Address - Street 1:436 S LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-3564
Mailing Address - Country:US
Mailing Address - Phone:540-949-8211
Mailing Address - Fax:540-949-4833
Practice Address - Street 1:436 S LINDEN AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-3564
Practice Address - Country:US
Practice Address - Phone:540-949-8211
Practice Address - Fax:540-949-4833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010020913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008500231Medicaid
VA9146377Medicaid
2102933OtherPK
VA9146377Medicaid
VA8500231Medicaid