Provider Demographics
NPI:1598757189
Name:RICHLANDS PHARMACY ASSOCIATES INC
Entity Type:Organization
Organization Name:RICHLANDS PHARMACY ASSOCIATES INC
Other - Org Name:RICHLANDS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-963-2115
Mailing Address - Street 1:2625 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-2225
Mailing Address - Country:US
Mailing Address - Phone:276-963-2115
Mailing Address - Fax:276-964-9769
Practice Address - Street 1:2625 FRONT ST
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-2225
Practice Address - Country:US
Practice Address - Phone:276-963-2115
Practice Address - Fax:276-964-9769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010019483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2102773OtherPK
VA8512817Medicaid
WV0850014000Medicaid
WV0850014000Medicaid