Provider Demographics
NPI:1568560506
Name:RAYFIELDS PHARMACY INC
Entity Type:Organization
Organization Name:RAYFIELDS PHARMACY INC
Other - Org Name:RAYFIELDS PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:757-442-6159
Mailing Address - Street 1:9502 HOSPITAL AVENUE
Mailing Address - Street 2:PO BOX 213
Mailing Address - City:NASSAWADOX
Mailing Address - State:VA
Mailing Address - Zip Code:23413
Mailing Address - Country:US
Mailing Address - Phone:757-442-6159
Mailing Address - Fax:757-442-2434
Practice Address - Street 1:2 FIG ST
Practice Address - Street 2:
Practice Address - City:CAPE CHARLES
Practice Address - State:VA
Practice Address - Zip Code:23310-3322
Practice Address - Country:US
Practice Address - Phone:757-331-1212
Practice Address - Fax:757-331-1306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010007333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2107232OtherPK
VA008509301Medicaid