Provider Demographics
NPI:1528035771
Name:CHS INC
Entity Type:Organization
Organization Name:CHS INC
Other - Org Name:CARILION MEDICAL CENTER PHARMACY, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:SHAWN REID
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-266-6191
Mailing Address - Street 1:2001 CRYSTAL SPRING AVE SW
Mailing Address - Street 2:SUITE 110 CARILION MEDICAL CENTER PHARMACY, INC
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014
Mailing Address - Country:US
Mailing Address - Phone:540-853-0906
Mailing Address - Fax:540-853-0910
Practice Address - Street 1:2001 CRYSTAL SPRING AVE SW
Practice Address - Street 2:SUITE 110 CARILION MEDICAL CENTER PHARMACY, INC
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014
Practice Address - Country:US
Practice Address - Phone:540-853-0906
Practice Address - Fax:540-853-0910
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-07
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
VA02010021173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4819150OtherNABP #
VA1528035771Medicaid
VA4819150OtherNABP #