Provider Demographics
NPI:1730112020
Name:GOOLRICKS MODERN PHARMARCY INC
Entity Type:Organization
Organization Name:GOOLRICKS MODERN PHARMARCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:540-373-3411
Mailing Address - Street 1:901 CAROLINE ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-5807
Mailing Address - Country:US
Mailing Address - Phone:540-373-3411
Mailing Address - Fax:
Practice Address - Street 1:901 CAROLINE ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5807
Practice Address - Country:US
Practice Address - Phone:540-373-3411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010028703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy