Provider Demographics
NPI:1083790901
Name:CHESAPEAKE PHARMACY SERVICES
Entity Type:Organization
Organization Name:CHESAPEAKE PHARMACY SERVICES
Other - Org Name:CHESAPEAKE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:LOCKSTAMPFOR
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:804-435-8582
Mailing Address - Street 1:PO BOX 1449
Mailing Address - Street 2:
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-1449
Mailing Address - Country:US
Mailing Address - Phone:804-435-8582
Mailing Address - Fax:804-435-8543
Practice Address - Street 1:95 HARRIS RD
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482
Practice Address - Country:US
Practice Address - Phone:804-435-6473
Practice Address - Fax:804-435-8667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010037603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4836485OtherNCPDP
VA4836485OtherNCPDP