Provider Demographics
NPI:1326077090
Name:NANTZ APOTHECARY
Entity Type:Organization
Organization Name:NANTZ APOTHECARY
Other - Org Name:POUND DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:NANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:276-796-5500
Mailing Address - Street 1:PO BOX 1090
Mailing Address - Street 2:11133 INDIAN CREEK RD
Mailing Address - City:POUND
Mailing Address - State:VA
Mailing Address - Zip Code:24279-1090
Mailing Address - Country:US
Mailing Address - Phone:279-796-5500
Mailing Address - Fax:279-796-2191
Practice Address - Street 1:11133 INDIAN CREEK ROAD
Practice Address - Street 2:
Practice Address - City:POUND
Practice Address - State:VA
Practice Address - Zip Code:24279
Practice Address - Country:US
Practice Address - Phone:279-796-5500
Practice Address - Fax:279-796-2191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205106183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9110682Medicaid
KY54003314Medicaid