Provider Demographics
NPI:1407165558
Name:FAMILY CARE PHARMACY INC
Entity Type:Organization
Organization Name:FAMILY CARE PHARMACY INC
Other - Org Name:FAMILY CARE PHARMACY BERRYVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:COMER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:540-955-2400
Mailing Address - Street 1:2576 GAYTON CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-6912
Mailing Address - Country:US
Mailing Address - Phone:804-740-3300
Mailing Address - Fax:866-323-5455
Practice Address - Street 1:401 GRAFTON LN
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:VA
Practice Address - Zip Code:22611-2577
Practice Address - Country:US
Practice Address - Phone:540-955-5747
Practice Address - Fax:540-955-5749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-06
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA2010040683336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1407165558Medicaid
2127155OtherPK