Provider Demographics
NPI:1720370927
Name:NORTHUMBERLAND PHARMACY INC
Entity Type:Organization
Organization Name:NORTHUMBERLAND PHARMACY INC
Other - Org Name:NORTHUMBERLAND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLL
Authorized Official - Middle Name:
Authorized Official - Last Name:THROCKMORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-435-8818
Mailing Address - Street 1:PO BOX 1299
Mailing Address - Street 2:
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-1299
Mailing Address - Country:US
Mailing Address - Phone:804-435-8818
Mailing Address - Fax:804-435-8898
Practice Address - Street 1:6954 NORTHUMBERLAND HWY
Practice Address - Street 2:
Practice Address - City:HEATHSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22473-3335
Practice Address - Country:US
Practice Address - Phone:804-580-4940
Practice Address - Fax:804-580-4942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-05
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4842868OtherNCPDP PROVIDER IDENTIFICATION NUMBER