Provider Demographics
NPI:1326116120
Name:DUBLIN PHARMACY
Entity Type:Organization
Organization Name:DUBLIN PHARMACY
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-674-5693
Mailing Address - Street 1:P.O. BOX 1228
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084
Mailing Address - Country:US
Mailing Address - Phone:540-674-5693
Mailing Address - Fax:540-674-8448
Practice Address - Street 1:703 BROAD ST.
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084
Practice Address - Country:US
Practice Address - Phone:540-674-5693
Practice Address - Fax:540-674-8448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201001440333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008545197Medicaid
VA8545197Medicaid
4826965OtherOTHER ID NUMBER-COMMERCIAL NUMBER