Provider Demographics
NPI:1255301321
Name:HANCOCK LAMBERT PHARMACY INC.
Entity Type:Organization
Organization Name:HANCOCK LAMBERT PHARMACY INC.
Other - Org Name:HANCOCK LAMBERT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:276-926-6707
Mailing Address - Street 1:PO BOX 1480
Mailing Address - Street 2:
Mailing Address - City:POUND
Mailing Address - State:VA
Mailing Address - Zip Code:24279-1480
Mailing Address - Country:US
Mailing Address - Phone:276-926-6707
Mailing Address - Fax:276-926-4482
Practice Address - Street 1:342 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTWOOD
Practice Address - State:VA
Practice Address - Zip Code:24228
Practice Address - Country:US
Practice Address - Phone:276-926-6707
Practice Address - Fax:276-926-4482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201000341333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008501611Medicaid