Provider Demographics
NPI:1497763098
Name:SOUTHWESTERN VIRGINIA MENTAL HEALTH REGIONAL PHARMACY
Entity Type:Organization
Organization Name:SOUTHWESTERN VIRGINIA MENTAL HEALTH REGIONAL PHARMACY
Other - Org Name:SOUTHWESTERN VIRGINIA TRAINING CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SINNETT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:276-728-9081
Mailing Address - Street 1:PO BOX 1328
Mailing Address - Street 2:
Mailing Address - City:HILLSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24343-7328
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:160 TRAINING CENTER RD
Practice Address - Street 2:
Practice Address - City:HILLSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24343-5149
Practice Address - Country:US
Practice Address - Phone:276-728-9081
Practice Address - Fax:276-728-4527
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWESTERN VIRGINA MENTAL HEALTH INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-03
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201003426315P00000X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008509654Medicaid
VA4815619OtherNABP #