Provider Demographics
NPI:1508134628
Name:PIEDMONT PHARMACY INC
Entity Type:Organization
Organization Name:PIEDMONT PHARMACY INC
Other - Org Name:PIEDMONT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:KISER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-251-4839
Mailing Address - Street 1:305 MOUNT CROSS RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-4045
Mailing Address - Country:US
Mailing Address - Phone:434-791-3784
Mailing Address - Fax:434-791-2554
Practice Address - Street 1:305 MOUNT CROSS RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-4045
Practice Address - Country:US
Practice Address - Phone:434-791-3784
Practice Address - Fax:434-791-2554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-03
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010044393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4843531OtherNCPDP PROVIDER IDENTIFICATION NUMBER
VA6697890001Medicare NSC