Provider Demographics
NPI:1114995487
Name:ERNIE'S DRUG, INC.
Entity Type:Organization
Organization Name:ERNIE'S DRUG, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:276-762-5800
Mailing Address - Street 1:16408 WISE ST
Mailing Address - Street 2:
Mailing Address - City:ST. PAUL
Mailing Address - State:VA
Mailing Address - Zip Code:24283
Mailing Address - Country:US
Mailing Address - Phone:276-762-5800
Mailing Address - Fax:276-762-0213
Practice Address - Street 1:16408 WISE ST
Practice Address - Street 2:
Practice Address - City:ST. PAUL
Practice Address - State:VA
Practice Address - Zip Code:24283
Practice Address - Country:US
Practice Address - Phone:276-762-5800
Practice Address - Fax:276-762-0213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201002335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1156070001Medicare NSC