Provider Demographics
NPI:1063445427
Name:FELTS DRUG STORE INC.
Entity Type:Organization
Organization Name:FELTS DRUG STORE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:ABERNATHY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:804-733-4403
Mailing Address - Street 1:2200 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-2758
Mailing Address - Country:US
Mailing Address - Phone:804-733-4403
Mailing Address - Fax:804-861-9460
Practice Address - Street 1:2200 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-2758
Practice Address - Country:US
Practice Address - Phone:804-733-4403
Practice Address - Fax:804-861-9460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0000379166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4808032OtherNABP