Provider Demographics
NPI:1275901159
Name:BUNTINGS DRUG CENTER LLC
Entity Type:Organization
Organization Name:BUNTINGS DRUG CENTER LLC
Other - Org Name:BUNTINGS AND NORTHSIDE DRUG CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-466-3600
Mailing Address - Street 1:1883 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-3605
Mailing Address - Country:US
Mailing Address - Phone:276-466-3600
Mailing Address - Fax:276-466-3578
Practice Address - Street 1:1883 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3605
Practice Address - Country:US
Practice Address - Phone:276-466-3600
Practice Address - Fax:276-466-3578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010019183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2153962OtherPK