Provider Demographics
NPI:1417040197
Name:D & S PHARMACY INC
Entity Type:Organization
Organization Name:D & S PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:HALLA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:757-489-4848
Mailing Address - Street 1:4712 HAMPTON BLVD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508
Mailing Address - Country:US
Mailing Address - Phone:757-489-4848
Mailing Address - Fax:757-489-9227
Practice Address - Street 1:4712 HAMPTON BLVD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23508-1822
Practice Address - Country:US
Practice Address - Phone:757-489-4848
Practice Address - Fax:757-489-9227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201002700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0619800001OtherMEDICARE PTAN
4824151OtherALL OTHER INSURANCE
VA8535744Medicaid
0619800001Medicare ID - Type Unspecified