Provider Demographics
NPI:1518042878
Name:CULPEPER PHARMACY LLC
Entity Type:Organization
Organization Name:CULPEPER PHARMACY LLC
Other - Org Name:CULPEPER HOME MEDCIAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:RANKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-825-7576
Mailing Address - Street 1:251 SOUTHGATE SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-3833
Mailing Address - Country:US
Mailing Address - Phone:540-825-7576
Mailing Address - Fax:540-825-5822
Practice Address - Street 1:251 SOUTHGATE SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3833
Practice Address - Country:US
Practice Address - Phone:540-825-7576
Practice Address - Fax:540-825-5822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201-003842332B00000X, 3336C0003X
VA0206009746332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
271420OtherANTHEM SECONDARY #
VA010122937Medicaid
4837413OtherNCPDP #
VA008519838Medicaid
4837413OtherNCPDP #