Provider Demographics
NPI:1760564082
Name:RADFORD DRUG, INC. T/A THE MEDICINE SHOPPE #1286
Entity Type:Organization
Organization Name:RADFORD DRUG, INC. T/A THE MEDICINE SHOPPE #1286
Other - Org Name:THE MEDICINE SHOPPE #1286
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:PERKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:540-639-3996
Mailing Address - Street 1:243 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-1584
Mailing Address - Country:US
Mailing Address - Phone:540-639-3996
Mailing Address - Fax:540-731-4852
Practice Address - Street 1:243 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-1584
Practice Address - Country:US
Practice Address - Phone:540-639-3996
Practice Address - Fax:540-731-4852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201000681332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4803412OtherNCPDP
VA0201000681OtherSTATE PHARMACY LICENSE
VA1811988827OtherNPI
VA1811988827OtherNPI
VA0201000681OtherSTATE PHARMACY LICENSE
VA=========OtherFEDERAL TAX ID