Provider Demographics
NPI:1346770856
Name:CLAYPOOL HILL PHARMACY
Entity Type:Organization
Organization Name:CLAYPOOL HILL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGRAW
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:276-963-3502
Mailing Address - Street 1:PO BOX 690
Mailing Address - Street 2:
Mailing Address - City:POUNDING MILL
Mailing Address - State:VA
Mailing Address - Zip Code:24637-0690
Mailing Address - Country:US
Mailing Address - Phone:276-963-3502
Mailing Address - Fax:276-963-3757
Practice Address - Street 1:12252 GOVERNOR G C PEERY HWY
Practice Address - Street 2:
Practice Address - City:POUNDING MILL
Practice Address - State:VA
Practice Address - Zip Code:24637-4272
Practice Address - Country:US
Practice Address - Phone:276-963-3502
Practice Address - Fax:276-963-3757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-18
Last Update Date:2017-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010040173336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010143080Medicaid