Provider Demographics
NPI:1609820307
Name:PARTNERS PHARMACY OF VIRGINIA, LLC
Entity Type:Organization
Organization Name:PARTNERS PHARMACY OF VIRGINIA, LLC
Other - Org Name:APEX CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-931-9111
Mailing Address - Street 1:70 JACKSON DRIVE
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016
Mailing Address - Country:US
Mailing Address - Phone:908-931-9111
Mailing Address - Fax:908-931-9328
Practice Address - Street 1:3737 W. MAIN ST.
Practice Address - Street 2:SUITE 103
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153
Practice Address - Country:US
Practice Address - Phone:540-444-1023
Practice Address - Fax:540-444-0444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010040863336L0003X
3336L0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1609820307Medicaid
2105926OtherPK
2105926OtherPK