Provider Demographics
NPI:1629102926
Name:PARTNERS PHARMACY OF VIRGINIA LLC
Entity Type:Organization
Organization Name:PARTNERS PHARMACY OF VIRGINIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP-PI
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:R
Authorized Official - Last Name:PALIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-931-9111
Mailing Address - Street 1:50 LAWRENCE RD.
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-3121
Mailing Address - Country:US
Mailing Address - Phone:908-931-9111
Mailing Address - Fax:908-931-9328
Practice Address - Street 1:1746 E PARHAM RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-2202
Practice Address - Country:US
Practice Address - Phone:804-262-2500
Practice Address - Fax:804-262-4800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010041413336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
6120650001Medicare NSC