Provider Demographics
NPI:1154308971
Name:FRIENDSHIP PHARMACY INC
Entity Type:Organization
Organization Name:FRIENDSHIP PHARMACY INC
Other - Org Name:FRIENDSHIP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-777-4044
Mailing Address - Street 1:P.O. BOX 7587
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012
Mailing Address - Country:US
Mailing Address - Phone:540-265-2152
Mailing Address - Fax:540-777-6865
Practice Address - Street 1:327 HERSHBERGER RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-1956
Practice Address - Country:US
Practice Address - Phone:540-265-2152
Practice Address - Fax:540-777-6865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
VA02010002863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2102841OtherPK
VA1154308971Medicaid
1042950001Medicare NSC