Provider Demographics
NPI:1174627368
Name:BAXTERS DRUG STORE
Entity Type:Organization
Organization Name:BAXTERS DRUG STORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMETT
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-478-4771
Mailing Address - Street 1:PO BOX 180
Mailing Address - Street 2:
Mailing Address - City:MCKENNEY
Mailing Address - State:VA
Mailing Address - Zip Code:23872-0180
Mailing Address - Country:US
Mailing Address - Phone:804-478-4771
Mailing Address - Fax:
Practice Address - Street 1:10359 DOYLE BLVD
Practice Address - Street 2:
Practice Address - City:MCKENNEY
Practice Address - State:VA
Practice Address - Zip Code:23872-0180
Practice Address - Country:US
Practice Address - Phone:804-478-4771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010028243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy