Provider Demographics
NPI:1114339959
Name:DR. TERRY SINCLAIR HEALTH CLINIC, INC. PHARMACY
Entity Type:Organization
Organization Name:DR. TERRY SINCLAIR HEALTH CLINIC, INC. PHARMACY
Other - Org Name:FREE MEDICAL CLINIC OF NOTHERN SHENANDOAH VALLEY. INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATRRINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:540-536-1681
Mailing Address - Street 1:301 N. CAMERON STREET,
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601
Mailing Address - Country:US
Mailing Address - Phone:540-536-1680
Mailing Address - Fax:540-662-4724
Practice Address - Street 1:301 N CAMERON STREET.
Practice Address - Street 2:SUITE 100
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-536-1680
Practice Address - Fax:540-662-4724
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR TERRY SINCLAIR HEALTH CLINIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-28
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
VA02010024043336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2158229OtherPK