Provider Demographics
NPI:1093876559
Name:O & B PHARMACY INC
Entity Type:Organization
Organization Name:O & B PHARMACY INC
Other - Org Name:LEE DAVIS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:DEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:SAWHNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-730-9200
Mailing Address - Street 1:7016 LEE PARK RD # 400
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-3682
Mailing Address - Country:US
Mailing Address - Phone:804-730-9200
Mailing Address - Fax:804-730-0029
Practice Address - Street 1:7016 LEE PARK RD STE 400
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-3682
Practice Address - Country:US
Practice Address - Phone:804-730-9200
Practice Address - Fax:804-730-0029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201002982333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1093876559Medicaid