Provider Demographics
NPI:1053652982
Name:SCOTTSVILLE PHARMACY LLC
Entity Type:Organization
Organization Name:SCOTTSVILLE PHARMACY LLC
Other - Org Name:SCOTTSVILLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:DANE
Authorized Official - Last Name:YONCE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:434-842-3208
Mailing Address - Street 1:295 E MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SCOTTSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24590-4995
Mailing Address - Country:US
Mailing Address - Phone:434-286-3881
Mailing Address - Fax:434-286-4733
Practice Address - Street 1:295 E MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:SCOTTSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24590-4995
Practice Address - Country:US
Practice Address - Phone:434-286-3881
Practice Address - Fax:434-286-4733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy