Provider Demographics
NPI:1265469779
Name:DAVIDSON'S PHARMACY, P.C.
Entity Type:Organization
Organization Name:DAVIDSON'S PHARMACY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-381-9345
Mailing Address - Street 1:1500 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-1412
Mailing Address - Country:US
Mailing Address - Phone:540-381-9345
Mailing Address - Fax:540-381-9346
Practice Address - Street 1:1500 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-1412
Practice Address - Country:US
Practice Address - Phone:540-381-9345
Practice Address - Fax:540-381-9346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA020210038183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008503150Medicaid
VA008503150Medicaid