Provider Demographics
NPI:1003942046
Name:VIRGINIA DEPARTMENT OF CORRECTIONS
Entity Type:Organization
Organization Name:VIRGINIA DEPARTMENT OF CORRECTIONS
Other - Org Name:CORRECTIONS PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-674-3119
Mailing Address - Street 1:6900 ATMORE DR RM 3127A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-5644
Mailing Address - Country:US
Mailing Address - Phone:804-674-3681
Mailing Address - Fax:804-674-3684
Practice Address - Street 1:6900 ATMORE DR RM 3127A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-5644
Practice Address - Country:US
Practice Address - Phone:804-674-3681
Practice Address - Fax:804-674-3684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201001317333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy