Provider Demographics
NPI:1083713945
Name:ROSE HILL PHARMACY
Entity Type:Organization
Organization Name:ROSE HILL PHARMACY
Other - Org Name:ROSE HILL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT PIC OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:276-445-5026
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:ROSE HILL
Mailing Address - State:VA
Mailing Address - Zip Code:24281-0220
Mailing Address - Country:US
Mailing Address - Phone:276-445-5026
Mailing Address - Fax:276-445-5029
Practice Address - Street 1:5462 DR THOMAS WALKER RD
Practice Address - Street 2:
Practice Address - City:ROSE HILL
Practice Address - State:VA
Practice Address - Zip Code:24281-8360
Practice Address - Country:US
Practice Address - Phone:276-445-5026
Practice Address - Fax:276-445-5029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010039143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54006150Medicaid
2105377OtherPK
VA008520186Medicaid
VA009999612Medicaid
VA008520186Medicaid