Provider Demographics
NPI:1639148521
Name:SHAWSVILLE PHARMACY INC
Entity Type:Organization
Organization Name:SHAWSVILLE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-268-2555
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:SHAWSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24162-0308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6920 ROANOKE RD
Practice Address - Street 2:
Practice Address - City:SHAWSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24162
Practice Address - Country:US
Practice Address - Phone:540-268-2555
Practice Address - Fax:540-268-5009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010023563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008515671Medicaid
VA009132341Medicaid
VA4820470OtherNCPDP
VA1770910655Medicaid
VA4844949OtherNCPDP
1237860001Medicare NSC
VA1237860002Medicare NSC