Provider Demographics
NPI:1720199573
Name:APPALACHIA PHARMACY INC
Entity Type:Organization
Organization Name:APPALACHIA PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EARNEST
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:276-565-0445
Mailing Address - Street 1:125 CALLAHAN AVE
Mailing Address - Street 2:
Mailing Address - City:APPALACHIA
Mailing Address - State:VA
Mailing Address - Zip Code:24216-1203
Mailing Address - Country:US
Mailing Address - Phone:276-565-0445
Mailing Address - Fax:276-565-1810
Practice Address - Street 1:125 CALLAHAN AVE
Practice Address - Street 2:
Practice Address - City:APPALACHIA
Practice Address - State:VA
Practice Address - Zip Code:24216-1203
Practice Address - Country:US
Practice Address - Phone:276-565-0445
Practice Address - Fax:276-565-1810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010021993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT4815215OtherNABP