Provider Demographics
NPI:1073104543
Name:COUNTS, ERVIN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ERVIN
Middle Name:
Last Name:COUNTS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:BIRCHLEAF
Mailing Address - State:VA
Mailing Address - Zip Code:24220-0147
Mailing Address - Country:US
Mailing Address - Phone:276-865-0204
Mailing Address - Fax:
Practice Address - Street 1:251 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HAYSI
Practice Address - State:VA
Practice Address - Zip Code:24256
Practice Address - Country:US
Practice Address - Phone:276-865-5560
Practice Address - Fax:276-865-5310
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202010366183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202010366OtherBOARD OF PHARMACY