Provider Demographics
NPI:1487669008
Name:MAO PHARMACY INC
Entity Type:Organization
Organization Name:MAO PHARMACY INC
Other - Org Name:WESTWOOD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:OLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-288-1933
Mailing Address - Street 1:5823 PATTERSON AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2536
Mailing Address - Country:US
Mailing Address - Phone:804-288-1933
Mailing Address - Fax:804-288-7934
Practice Address - Street 1:5823 PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2536
Practice Address - Country:US
Practice Address - Phone:804-288-1933
Practice Address - Fax:804-288-7934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010021283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4808777OtherNCPDP PROVIDER IDENTIFICATION NUMBER
4808777OtherNCPDP PROVIDER IDENTIFICATION NUMBER