Provider Demographics
NPI:1376075283
Name:AUGUSTA REGIONAL CLINIC PHARMACY
Entity Type:Organization
Organization Name:AUGUSTA REGIONAL CLINIC PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:BENN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-221-6723
Mailing Address - Street 1:342 MULE ACADEMY RD
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2256
Mailing Address - Country:US
Mailing Address - Phone:540-221-6723
Mailing Address - Fax:540-221-6748
Practice Address - Street 1:342 MULE ACADEMY RD
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2256
Practice Address - Country:US
Practice Address - Phone:540-221-6723
Practice Address - Fax:540-221-6748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010031313336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy